Connecticut House Delegation Requests Federal Investigation Into CMS Oversight Of UnitedHealth Group’s Unprecedented Actions

NEW HAVEN, CT—Congresswoman Rosa DeLauro (CT-3) today announced she, along with the rest of Connecticut’s delegation to the U.S. House of Representatives, is asking the Government Accountability Office (GAO) to investigate the Center for Medicare and Medicaid Services (CMS) oversight of the Medicare Advantage Program in light of UnitedHealth Group’s unprecedented elimination of many health providers from their Medicare Advantage networks.

 

 

The delegation’s letter asks GAO to answer the following questions:

 

1.      What is the underlying evidence or basis for the Center for Medicare and Medicaid Services (CMS)’s criteria for Medicare Advantage plan network adequacy and to what extent has this changed over time? 

2.      To what extent does CMS ensure that the providers in Medicare Advantage plan networks are able to meet the needs of their enrollees?

3.      How, and to what extent, does CMS ensure that Medicare Advantage plans establish and maintain adequate networks of providers?  Are they reviewed when provider networks are significantly reduced? 

4.      Does CMS ensure that beneficiaries have accurate information on Medicare Advantage plans’ provider networks before open enrollment? 

5.      To what extent does CMS ensure that Medicare Advantage plans comply with CMS regulatory notification requirements for providers and beneficiaries when reductions are made to a provider network?