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The annual RISE National Conference offers an opportunity for mid- to senior-level executives from managed care organizations (MCOs) to come together, share insights and perspectives, and learn about the trends and technologies shaping the healthcare industry. Here are some of the key insights we learned at RISE National 2024.
OIG: MCOs Must Do Better
RISE National 2024 featured keynote addresses from the OIG, DOJ, and CMS on the regulatory landscape. In her address, Inspector General Christy Grimm reiterated that no one is immune from regulatory scrutiny, and the OIG is prepared to investigate and penalize any healthcare organization or vendor that fails to comply with CMS guidelines.
Overall, this year’s message was similar to last year’s: MCOs are on thin ice. Risk adjustment and prior authorization are still not working as intended, and MCOs must focus on shoring up their processes in both areas to avoid financial penalties or even prosecution.