April 21, 2022

Mike Adelberg Discusses Medicare Advantage Benefits and CMS Penalties

According to AIS Health’s RADAR on Medicare Advantage publication, Centers for Medicare & Medicaid Services (CMS) imposed a total of nearly $1 million in civil monetary penalties (CMPs) between February and April of 2022. Faegre Drinker Consulting Principal Mike Adelberg commented on the design of Medicare Advantage benefits and penalties imposed by CMS.

Adelberg remarked, “There are benefits that bleed across categories — in-home support bleeds into caregiver support which bleeds into respite care and adult day care. Without consulting individual EOCs [evidence of coverage documents], it’s really hard to know the precise difference between benefits in some of these benefit categories.”

“What’s most remarkable about the CMPs is how unremarkable they are,” said Adelberg. “The Biden-run CMS program audits are pretty consistent with the Trump-run CMS program audits — at least so far.”

The full article is available for RADAR on Medicare Advantage subscribers.


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