Why Actuarial Equivalence Matters for Medicare Advantage

June 26, 2017 – The requirement that health insurance companies participating in the Medicare Advantage program be paid in a manner that “ensures actuarial equivalence” to traditional fee-for-service Medicare poses important implications for any stakeholder interested in an accurate and fair Medicare Advantage payment process. This article, “Why Actuarial Equivalence Matters for Medicare Advantage,” by Butler Rubin partner Ursula Taylor explains the concept of actuarial equivalence within the Medicare Advantage payment model.  It further describes a lawsuit brought by Medicare Advantage Organization UnitedHealthcare seeking to enforce the requirement of actuarial equivalence as it relates to a 2014 CMS Overpayment Rule and the recent increase in unsealed lawsuits alleging False Claims Act liability for purported risk adjustment “overpayments.”