On Tuesday, June 28, the House Energy & Commerce Committee’s Oversight & Investigations Subcommittee held a hearing on Medicare Advantage (MA), featuring witnesses from the Office of the Inspector General, the Government Accountability Office, and the Medicare Payment Advisory Commission.
At a high level, the hearing examined the quality of care that Medicare beneficiaries receive through MA and the fiscal sustainability of the program. During the questioning portion of the hearing, several Members expressed concern with burdensome utilization management requirements and highlighted reform legislation related to prior authorization in Medicare Advantage.
Prior to the hearing, CSRO reached out to Members of the Subcommittee to provide background on some of the issues that rheumatologists encounter with MA plans. As a result, one of the Members asked a question for the record related to large volume medical record requests by MA plans, which present a severe burden on practice resources. The question asked the witnesses for steps CMS can take to prevent inappropriate diagnosis mining audits by MA plans and whether there are additional authorities the agency needs from Congress to effectively tackle this problem.
