CMS sanctions UnitedHealthcare plan: 3 things to know

One of UnitedHealthcare’s Medicare Advantage plans will face enrollment restrictions for 2020 due to compliance issues, according to the Star Tribune.

Advertisement

Three things to know:

1. CMS sanctioned the UnitedHealthcare plan because for the third year in a row, the plan didn’t adhere to a rule requiring it to have a medical loss ratio of at least 85 percent. A medical loss ratio measures how much of an insurer’s revenue goes toward medical claims versus overhead costs.

2. UnitedHealthcare said despite added benefits, the plan fell out of compliance because of a federal legislation reducing the health insurer’s tax liability for 2018.

3. Enrollment for the affected plan will be suspended for the 2020 contract year. The health plan is sold in nine states to less than 1 percent of UnitedHealthcare’s Medicare Advantage members. 

More articles on payers:
Verdict for ex-BCBS of North Carolina CEO: Guilty of DWI, child abuse charges
BCBS of Texas unveils first of 10 primary care clinics
The 2020 Medicare plans with 5 stars

At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.

Download Whitepaper

The cost-saving opportunity most health systems overlook

Many hospitals and health systems scrutinize staffing, service lines, and payer contracts for savings. Fewer look at one of their largest assets: real estate.…

Advertisement

Next Up in Legal & Regulatory Issues

Advertisement

Comments are closed.