ACI Legal, Regulatory, and Compliance Summit on Medicare Advantage
BRG’s Health Analytics practice sponsored the inaugural American Conference Institute Legal, Regulatory, and Compliance Summit on Medicare Advantage on October 12-13.
Alex Oliphant took part in the panel “How to Bolster Compliance and Avoid Costly Penalties” on October 12. Topics included:
- Defining medical loss ratio (MLR)
- Examining MLR reporting and enforcement historically, and the risks associated with MLR submissions
- Examining data reporting considerations for MLR data submissions
- Assessing legal risks posed when submitting MLR data and how to mitigate those risks
Julie Nielsen spoke in the panel “Forecasting Future Enforcement and the Implications for the Compliance and Legal Landscape” on October 13. Risk adjustment is being heavily scrutinized by government agencies in an effort to prevent and address fraud, waste, and abuse in the administration of the Medicare Advantage (MA) program. For MA organizations, navigating the complexities of risk adjustment to ensure data accuracy and compliance is of the utmost importance—as a failure to do so can lead to costly consequences. This session examined the influence of the legal landscape, key oversight channels, and compliance best practices.