Why Actuarial Equivalence Matters For Medicare Advantage

By Ursula Taylor (June 26, 2017, 11:55 AM EDT) -- The phrase "actuarial equivalence" denotes a concept that is potentially complicated, maybe even intimidating, and certainly a mouthful to articulate. But a requirement that health insurance companies participating in the Medicare Advantage program be paid in a manner that "ensures actuarial equivalence" to traditional fee-for-service Medicare poses important implications for any stakeholder interested in an accurate and fair Medicare Advantage payment process. It is the centerpiece of a litigation challenge to a federal "overpayment" rule requiring Medicare Advantage organizations to return unsupported payments to the government or be exposed to treble damages, fines or other penalties. This article explains the concept of actuarial equivalence within the Medicare Advantage payment model and why it matters, particularly at this time when there is an increased focus by enforcement authorities, whistleblowers and politicians on the recovery of potential "overpayments" received by health insurers under the Medicare Advantage program....

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