150 billion reasons Medicare Advantage matters
Eleven years ago, Congress created private Medicare Advantage health plans to help control health care spending on the elderly. The plans now cover nearly 16 million seniors at an estimated cost to taxpayers of more than $150 billion this year, but our latest investigation found that manipulation of a Medicare Advantage payment tool called a “risk score” is adding billions to the program's cost. Our Multimedia Editor Eleanor Bell sat down with the project reporter Fred Schulte to talk about some of his findings.
Eleanor Bell: The government is wasting tens of billions of dollars by overpaying private health insurers that inflate how sick their patients are.
That's the key finding of a new Center report by journalist Fred Schulte.
For more than a year, he’s been investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run mostly by private companies.
At the heart of the story are allegations that some big insurers are ripping off the taxpayer and questions about why the government is doing so little to stop it.
The report finds that not only has Washington known about this for years, but it has records of who’s responsible and refuses to release them.
Related: Audio: Reporter Fred Schulte discusses Medicare Advantage investigation
Now the Center for Public Integrity is suing to make those files public.
We’ll have more about that in a moment, but firstly Fred, let’s start from the beginning:
Medicare Advantage was introduced by Congress more than a decade ago to stabilize health care costs, has it been effective?
Fred Schulte: Well it’s been very effective for many patients. Witness the fact that it’s grown dramatically and now has over 16 million members in various Medicare Advantage plans. Many people like it because it costs them less out of pocket than the standard Medicare and so it’s expected to grow even further. So it’s a very effective program for many people.
What we were looking at was more the financial aspects of it — as to whether the payments are being made properly and whether some of the health plans are being overpaid and whether too much taxpayer money is going down the tube.
EB: And what did you find?
Related: More in the 'Medicare Advantage Money Grab' series
There’s more to this story. Click here to read the rest at the Center for Public Integrity.
This story is part of Medicare Advantage Money Grab. Billing errors cost taxpayers billions. Click here to read more stories in this investigation.
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Copyright 2014 The Center for Public Integrity. This story was published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.
