First MLR Audits Are Positive News for Health Insurers, but Risks Remain

Published in the American Health Lawyers Association , Health Care Liability and Litigation Practice Group Newsletter


This article discusses recent audit activity of medical loss ratio reporting, a provision of the Affordable Care Act. While California provided certain insurers with a clean bill of health, audit risks remain as the Department of Health and Human Services implements its audit procedures, which it has indicated will include data analytics as a means of conducting audit and enforcement activities. We also provide an overview of how health insurers may reduce risks of fines and penalties by ensuring appropriate documentation requirements and performing their own data analytics.  

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