Hidden audit reveals millions of overcharges on Medicare Advantage plans

News: Hidden audit reveals millions of overcharges on Medicare Advantage plans.

A summary of 90 audits examining accounts from 2011-2013 was obtained exclusively from KHN in a three-year Freedom of Information Act lawsuit that was settled in late September.

A newly released state audit found widespread overcharges and other errors in payments to Medicare Advantage health insurance plans, with some government plans overpaying by an average of $1,000 or more per patient per year. Billing is done.

A government audit revealed about $12 million in overpayments for the treatment of 18,090 of her patients under investigation, but the actual loss to taxpayers is far greater than that. Much more likely. Medicare Advantage is a fast-growing replacement for the original Medicare and is operated primarily by large insurance companies.

Officials at the Centers for Medicare & Medicaid Services say they plan to extrapolate payment failure rates from these samples to total membership for each plan. This will recover an estimated $650 million from insurers But now, nearly ten years later, that hasn’t happened. CMS had planned to release its final extrapolation rules on November 1, but recently he postponed that decision until February.

Ted Doolittle, a former associate director of the Center for Program Integrity at CMS, who oversees Medicare’s efforts to combat fraud and fraudulent claims, said the agency failed to hold Medicare Advantage accountable for his plan. I was. “I think CMS has failed its job,” said Doolittle, now a health advocate for Connecticut. Doolittle said CMS appears to be “watering” the insurance industry and is “making a profit” on Medicare Advantage plans. “It looks pretty stinky from the outside,” he said.

In an emailed response to written questions from KHN, CMS assistant administrator Dara Corrigan said the agency did not say how much it owed for health insurance because the calculations were “not yet completed.” said.

Corrigan didn’t say when the agency would be shutting down. “We have a legal fiduciary duty to address improper payments in all programs,” she said.

Enrollment in Medicare Advantage plans has more than doubled in the last decade he
He said CMS has only performed 90 audits in the past decade, when Medicare Advantage has exploded. Enrollment in the plan more than doubled over that period, surpassing 28 million by 2022, costing the government $427 billion.

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