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By Fred Schulte, Center for Public Integrity 

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

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.

 By Fred Schulte, Center for Public Integrity 
The entrance to the Humana headquarters in Louisville, Kentucky.

The entrance to the Humana headquarters in Louisville, Kentucky.

 

Insurance giant Humana Inc., which operates some of the nation’s largest private Medicare health plans, knew for years of billing fraud at some South Florida clinics, but did little to curb the practice even though it could harm patients, a doctor alleges in a newly unsealed whistleblower lawsuit.

The suit was filed by Boynton Beach physician Mario M. Baez. It accuses Humana, and his former business partner, Dr. Isaac K. Thompson, of engaging in a lucrative billing fraud scheme that lasted years. The suit also names three other Palm Beach County doctors, two medical clinics and a doctors’ practice group as defendants. The suit was filed in October 2012, but remained under a federal court seal until Feb. 26.

By Fred Schulte, Center for Public Integrity medicarecard

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.

By Fred Schulte, Center for Public Integrity 

The entrance to Humana headquarters in Louisville, Kentucky

The entrance to Humana headquarters in Louisville, Kentucky

Giant health insurer Humana, Inc. faces new scrutiny from the Justice Department over allegations it has overcharged the government by claiming some elderly patients enrolled in its popular Medicare plans are sicker than they actually are.

The Louisville, Kentucky-based company disclosed the Justice Department’s recent civil “information request” in an annual report filed with the Securities and Exchange Commission on Feb. 18. The company noted that it is cooperating with authorities.