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Advantage plans took from Medicare $11billion+ fraudulent & erroneous payments in 2022 alone. [1]
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Date: 2022-12-16
h/t dmhlt 66
The obvious root of the problem on the industry end is profit. The apparent root of the problem on the government end is that Medicare is only set up for annual audits of about 5% of Medicare Advantage plans routinely.
Dara Corrigan, a CMS deputy administrator, said that as a “general matter,” its Medicare Advantage audits “are not designed to detect fraud, nor are they intended to identify all improper diagnosis submissions.”…
KHN.org permits free republishing of their articles on this matter —e.g., “How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions” — but they’re too long and heavily detailed to do that in DK. To start with, though, KHN filed a a Freedom of Information Act lawsuit to obtain exclusive release of a review of 90 government audits that together showed health insurers issuing Medicare Advantage plans to have repeatedly sought to sidestep regulations requiring documentation of medical conditions the US government paid them to treat 2011-2013.
..The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans. CMS has estimated the total overpayments to health plans for the 2011-2013 audits [alone] at $650 million, yet how much it will eventually claw back remains unclear...
h/t Union Matters
Medicare was never adequately equipped with the teeth necessary for vigorously clamping down on Advantage-plan fraud, neither preventively nor punitively. The insurance industries, however, vigorously advanced the concept —popularly called Medicare “Part C” — and recruited the support of disabled people and seniors and their families, with promises of
You begin to get the picture, if you hadn’t long since. So, here’s the DK tag for diaries about or including the topic of Medicare Advantage. And for readers unfamiliar with KHN’s nonprofit public-interest health-policy&medical-sector publishing, here’s the wikipedia article: Kaiser Health News comes from the Kaiser Family Foundation, NOT affiliated with or connected to —thank god — KaiserPermanente, or KaiserPermanenteVentures (the for-profit investment arm of the for-profit KP branch that constitutes all physicians there).
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[1] Url:
https://www.dailykos.com/stories/2022/12/16/2141754/-Advantage-plans-took-from-Medicare-11billion-fraudulent-amp-erroneous-payments-in-2022-alone
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