Carol Berman, of West Palm Beach speaks with pedestrians about the need for policymakers to protect Medicare Advantage benefits during the Coalition for Medicare Choices’ Medicare Advantage Food Truck stop on North Capitol Street in Washington on Monday, March 9, 2015. Photo: Bill Clark/CQ Roll Call
Private Medicare Advantage plans treating the elderly have over-billed the government by billions of dollars, but rarely been forced to repay the money or face other consequences for their actions, according to a new Congressional audit.
In a sharply critical report made public Monday, the Government Accountability Office called for “fundamental improvements” to curb overbilling by the health plans, which are paid more than $160 billion annually. The privately run plans, an alternative to traditional fee-for-service Medicare, have proven popular with seniors and have enrolled more than 17 million people. The plans, which were the subject of a Center for Public Integrity investigation, also enjoy strong support in Congress.
Government audits just released as the result of a lawsuit detail widespread billing errors in private Medicare Advantage health plans going back years, including overpayments of thousands of dollars a year for some patients.
Since 2004, privately run Medicare Advantage plans, an increasingly popular alternative to traditional Medicare, have been paid using a risk score calculated for each patient who joins. Medicare expects to pay higher rates for sicker people and less for those in good health.
The third of February 2011 was mostly a ho-hum day on Wall Street — but not for companies offering Medicare Advantage plans. Several of those firms hit the jackpot, tacking on billions of dollars in new value after federal officials signaled they might go easy on health plans suspected of overcharging the government.
The stocks took off after the federal Centers for Medicare and Medicaid Services advised the health plans in a memo that it was rethinking a move to ratchet up audits of the privately run Medicare plans. Some of these plans are run by publicly traded insurance companies whose fortunes can rise and fall significantly upon news of a change in Medicare policy.
HHS headquarters in Washington, D.C. Photo: Matt Bisanz/Wikimedia Commons
Thousands of doctors across the country are billing Medicare for routine medical care at rates far above their peers, potentially costing taxpayers tens of millions of dollars in overcharges, according to a new government report.
The audit released Wednesday by the U.S. Department of Health and Human Services Office of Inspector General stopped short of accusing the high-billing doctors of ripping off the government health plan for the elderly. But it stated that Medicare’s payment scales for doctors have been “vulnerable to fraud and abuse” in recent years.