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Medicare Advantage: Star Ratings, Audits, And Compliance Findings

posted by AHIP

on February 9, 2017

What Is the Star Ratings System?

The Star Ratings System evaluates the quality of care beneficiaries receive from Medicare Advantage and Part D plans on a 1 to 5 scale based on performance on more than 40 individual measures. The system was originally developed to help beneficiaries choose between available plans.

Medicare Advantage plans with higher Star Ratings of at least 4 stars receive increased funding as an incentive to achieve high performance. Plans use these funds to provide additional benefits and reduce beneficiary cost-sharing.

Star Ratings and Audits: By the Numbers

ma_staraudits_5The number of measures in the Star Ratings System that reflect audit findings and enforcement actions, either directly or through the CMS data integrity policy.

 

ma_staraudits_68The percent of Medicare Advantage enrollees in plans with Star Ratings that were negatively impacted by audit findings or enforcement actions, representing 12.5 million beneficiaries.

 

ma_staraudits_2-2
The number of beneficiaries in 3.5 Star plans in 2017 that had 4+ Stars in 2016 but were penalized for audit findings or enforcement actions.