Probe of Private Medicare Insurers’ Business Practices Sought

Two members of the House Ways and Means Committee are calling on the Government Accountability Office to investigate Medicare managed care plans’ increasing purchase of health-related businesses—which may allow them to skirt federal requirements to spend at least 85% of their revenue on health care for beneficiaries.

Reps. Lloyd Doggett (D-Texas), ranking member of the Ways and Means Health Subcommittee, and Greg Murphy (R-N.C.), also a member of the panel, want a detailed investigation and report on the vertical integration of Medicare Advantage organizations (MAOs) and its effect on their 85% medical loss ratio (MLR) calculations.

Private Medicare Advantage plans, ...