Proposed Reforms and Industry Pushback

In early 2023, the Centers for Medicare & Medicaid Services (CMS) proposed reforms to address fraud and abuse within Medicare Advantage, focusing on curbing “upcoding” and reducing denials of care. These changes aimed to protect taxpayer dollars and improve patient care. However, the insurance industry quickly rallied against these reforms, with groups like the Coalition for Medicare Choices and the Better Medicare Alliance launching widespread lobbying and advertising campaigns. They framed the reforms as harmful to seniors, creating fear about potential benefit cuts. As a result of this intense pressure, CMS compromised by phasing in the changes over three years and increasing reimbursement rates for 2024. While the industry succeeded in delaying full implementation, the partial success of the reforms suggests there may be momentum for more significant changes in the future.