OIG’s latest Medicare Advantage guidance highlights growing scrutiny around prior authorization, marketing practices, third-party oversight, and compliance governance across integrated healthcare organizations.
The HHS OIG’s newest Medicare Advantage Industry Segment-Specific Compliance Program Guidance (MA ICPG) outlines several operational and compliance risks that Medicare Advantage organizations should be evaluating closely.
In this article, we examine four major areas highlighted by OIG:
- Access to care and utilization management tools, including prior authorization
- Marketing and enrollment practices
- Oversight of third parties and delegated entities
- Compliance programs within vertically integrated organizations and complex ownership structures
The guidance reflects increasing regulatory focus on how MA organizations manage beneficiary access to care, oversee vendors and downstream entities, monitor marketing conduct, and coordinate compliance across affiliated organizations.
Looking for Part 1? You can find it here.