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Kirk Nahra Discusses CMS Proposal to Limit Fraud Costs in Medical Loss Ratios

Bloomberg BNA’s Health Law Resource Center
June 8, 2015

Kirk J. Nahra, chair of Wiley Rein’s Privacy Practice and co-chair of the Health Care Practice, was quoted in a recent Bloomberg BNA article about a proposed rule that would limit Medicaid managed care plans’ fraud prevention expenditures to 0.5% of premium revenue when calculating medical loss ratios.

The fraud prevention limit, proposed last month by the Centers for Medicare & Medicaid Services, is somewhat confusing, Mr. Nahra told BNA’s Health Law Resource Center.

“Fraud in managed care has always been confusing, and this seems to be telling these carriers that fraud matters, but only a little,” he said.