Medicare & Medicaid
The health system cited denials and delayed prior authorization requests in making the move, as well as its financial position.
Intermediate sanctions, effective on January 12, are due to low Medicare Advantage star ratings.
The approval, the agency says, allows New York to make large investments in wide-ranging Medicaid initiatives.
"We take our members and treat them really, really nicely," says CMO Neil Wagle.
Two of company's MA plans earned 5 stars in 2024, during a difficult year to rank highly in the Medicare Advantage star ratings.
The disincentive structure proposed is excessive and threatens the financial viability of economically fragile hospitals, AHA says.
Rebates bring down prices by as much as half.
A corrective action process would allow providers to rectify conduct without dissuading them from participating in Medicare, MGMA says.
Humana opposes the transfer to the Dallas division, DOJ says.
More than half of Medicare's 66 million beneficiaries are opting for a MA plan, which is likely to further strain the health system.