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Errant Medicare Advantage Plans Struggled with Appeals Mechanism

By CQ Staff

October 11 2007 – Medicare Advantage plans slapped with "corrective action plans" because of rules violations have had difficulty meeting requirements for marketing, appeals, and grievance procedures and for giving proper notice that they are terminating hospital and other provider services, according to an analysis by the Gorman Health Group consulting firm.

On Oct 1, the Centers for Medicare and Medicaid Services (CMS) released 91 corrective action plans based on audits completed from January 2006 through Sept. 30, 2007. The Gorman Group analysis found that 94 percent of the affected plans had difficulty meeting CMS appeals and grievance requirements, while 61 percent failed to provide proper termination notices of hospital, skilled nursing facility, or home health agency services. Sixty-two percent were cited for improper marketing activities, including those that "mislead, confuse or misrepresent" beneficiaries.

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