Investigation Requested into Medicare Advantage Plan Business Practices

Two prominent members of the U.S. House Ways and Means Committee, Reps. Lloyd Doggett and Greg Murphy, have raised concerns around the business strategies of Medicare managed care organizations. These lawmakers are urging the Government Accountability Office to probe into the Medicare Advantage organizations' (MAOs) increasing tendency to acquire health-related businesses.

This practice potentially allows MAOs to navigate around federal mandates requiring a minimum of 85% of their revenues to be spent on direct patient care. The inquiry aims to ensure that the vertical integration strategies of these organizations do not adversely affect their mandated medical loss ratios (MLR), thus safeguarding beneficiary care.