Major changes are underway in the Medicare Advantage (MA) landscape — bringing both concern and opportunity for Florida’s home health providers. A sweeping federal lawsuit and an aggressive new audit initiative by the Centers for Medicare & Medicaid Services (CMS) are sending a clear message: the federal government is taking long-overdue action to restore accountability, transparency, and fairness to the nation’s fastest-growing Medicare program.

To ensure Florida’s home care providers are part of the conversation, HCAF is gathering frontline insights through a short survey on provider experiences with MA plans. Your input will help us document systemic barriers, inform federal policy recommendations, and shape the narrative during our upcoming fall fly-in to Washington, D.C., hosted by the National Alliance for Care at Home.

Why This Matters

Earlier this month, the U.S. Department of Justice (DOJ) filed a landmark lawsuit alleging that several of the nation’s largest health insurers paid hundreds of millions in illegal kickbacks to brokers who enrolled seniors into high-margin MA plans. These practices allegedly led to inappropriate enrollments, denials of needed services, and discriminatory conduct targeting people with disabilities — confirming concerns long raised by home care providers about misaligned incentives and delayed access to care.

At the same time, CMS has launched the most expansive MA audit initiative in the program’s history. Starting this year, the agency will:

• Audit every Medicare Advantage contract annually, up from just 50-60 per year;
• Expand record reviews from 35 to up to 200 per plan;
• Clear its audit backlog for 2018-2024 payment years by early 2026;
• Deploy advanced data tools and 2,000 medical coders to expedite and expand oversight.

These actions are aimed at addressing what the Medicare Payment Advisory Commission (MedPAC) estimates to be $17-$43 billion in annual MA overpayments, and they are expected to reshape the regulatory landscape for years to come.

Why Your Voice is Critical

While CMS’s actions primarily target health plans and brokers, the effects may directly impact providers — particularly through audit-related recoupments passed downstream under contract provisions. Your firsthand experience with denials, authorization delays, and documentation burdens is critical to illustrating how these policies affect patient care and frontline operations.

HCAF will use the survey findings to inform our formal letter to Florida’s congressional delegation and shape our messaging during in-person meetings on Capitol Hill during the September 8-10 advocacy fly-in in Washington, D.C.

What We’re Asking

The survey includes questions on:

• Authorization delays and denials
• Claims processing and payment issues
• Experiences with MA plans and third-party administrators
• Audit activity and compliance concerns

Please complete the survey by Friday, August 29 at 5:00 PM to ensure your feedback is included in our letter to Congress. The survey takes less than 10 minutes to complete, and responses may be submitted anonymously. If you choose to provide your contact information, it will only be used for follow-up — with your permission.

TAKE THE SURVEY NOW

HCAF is committed to ensuring that Florida’s home care providers are not only heard, but prioritized in the national conversation on MA reform. Thank you for your participation!