GAO takes on Medicare Advantage spending
A Congressional committee has taken aim at waste in the popular Medicare Advantage health insurance program for seniors, ordering an extensive audit of billing errors and overcharges by insurers — mistakes estimated to cost taxpayers billions of dollars every year.
The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of the House Ways and Means Committee. Results are due next spring.
GAO auditors will target efforts by the Centers for Medicare and Medicaid Services (CMS), which runs the senior care program, to ensure the privately run health plans are paid accurately and that any overpayments are recovered for taxpayers. Medicare Advantage is an alternative to standard Medicare and is mostly run by private insurance carriers.
“Right now everything is on the table,” said James Cosgrove, who heads the GAO’s health care division. “This is not something we have focused on before.”
The GAO audit comes in the wake of the Center for Public Integrity’s “Medicare Advantage Money Grab” series published in June, which showed that the government has struggled for years to stop the health plans from charging too much.
The series found that federal officials made nearly $70 billion in “improper” payments to health plans — mostly inflated fees from overstating patients’ health risks — from 2008 through 2013 alone.
Medicare pays health plans using a complex formula known as a risk score, which is supposed to raise rates for sicker patients and lower them for people in good health. But the industry has long faced criticism that some plans overstate how sick some patients are to boost Medicare revenue, a practice known as “upcoding.”
“Given the prevalence of upcoding by some MA plans, we hope that the GAO audit will result in CMS paying plans more accurately and fairly while reducing wasteful overpayments,” said David A. Lipschutz, an attorney with the Center for Medicare Advocacy in Washington.
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.
