The Centers for Medicare and Medicaid Services must strengthen its oversight of Medicare Advantage contracts by examining data on disenrollment by health status and the reasons beneficiaries dis-enroll in the first place. Currently, CMS does not use available data to gain such insight.
That’s the finding of a new Government Accountability Office audit that examined 126 Medicare Advantage contracts with higher disenrollment rates—above the median rate of 10.6 percent—and found 35 contracts with health-biased disenrollment.
In these contracts, beneficiaries in poor health were substantially more likely (on average, 47 percent more likely) to dis-enroll relative to beneficiaries in better health, according to auditors, who concluded that such disparities in contract disenrollment by health status may indicate that the needs of beneficiaries—particularly those in poor health—may not be adequately met.
“CMS does not use available data to examine data on disenrollment by health status as part of its ongoing oversight; thus, CMS may fail to identify problems in MA contract performance, which poses a risk as contracts are prohibited from limiting coverage based on health status,” states the GAO report.
In addition, auditors found that the agency’s oversight is inconsistent with internal control standards.
A CMS spokesperson declined to specifically comment on the GAO’s findings and recommendations, and instead referred to the agency’s official written response published in the audit report.
The Department of Health and Human Services’ written response to the GAO concurs with the recommendation that HHS examine disenrollment data by health status and the reasons that beneficiaries dis-enroll.
“HHS currently uses disenrollment data in its review of quality and performance of MA plans and through the MA Star Ratings,” states the department. “However, HHS will continue to consider ways to incorporate disenrollment data into its oversight of MA plans.”
Last year, more than 30 percent of Medicare beneficiaries were enrolled in the MA program, through which CMS contracts with private entities to offer medical coverage. MA enrollment has increased from 11.1 million in 2010 to 17.6 million in 2016.
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