Crack Down On Medicare Advantage Overbilling

http://www.pharmaciststeve.com/?p=10508

Senate Judiciary Committee Chairman Chuck Grassley has asked Attorney General Loretta Lynch to tighten scrutiny of Medicare Advantage health plans suspected of overcharging the government, saying billions of tax dollars are at risk as the popular senior care program grows. In May 19 letters to Lynch and Andrew M. Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, Grassley wanted to know what both agencies have done, together and apart, to stamp out overcharges that have plagued the privately run insurance program for years…

On April 14, DaVita Healthcare Partners Inc., headquartered in Denver disclosed that Justice Department investigators had subpoenaed Medicare Advantage billing data and other records from January 2008 through the end of 2013…

A Republican complaining about the overcharging of a privately-run health care program? That’s so… ironic.

12 thoughts on “Crack Down On Medicare Advantage Overbilling

  1. but, aren’t they publicly run, in that medicare is funded by the federal government and medicaid is funded by both state and federal government? and aren’t they supplied to populations which can neither afford private insurance nor be eligible for it?

    but of course, good oversight is needed to make sure there is no waste or over charging. but that should not be used to decide which patients get what treatment or rx’s or in limiting options to the patient.

    Liked by 1 person

    • I don’t know much about the Medicare Advantage program, but it’s described as privately-run, which is something Republicans just love. In fact, they’ve always wanted to privatize Medicare, just like conservatives in the U.K. want to privatize the NHS. For some reason, they think competition will lower prices, when it just opens the door to more fraud and abuse (without oversight).

      Liked by 1 person

      • FYI, on Medicare Advantage being “privately run,” that does not mean it is privatized. Medicare Advantage is an option within public Part C of Medicare. And all Parts of Medicare — A, B, B DME and D as well as C — are “privately run” (that is, they are administered by insurance companies under contract to the government).

        As Part of Medicare (and despite the implications of the article you read), there is extensive oversight. More important, in Medicare the government can claw back any overpayments it finds. (Also do not confuse overpayments with fraud and abuse.)

        Liked by 2 people

  2. well medicare advantage plans are complete plans (hospital, outpatient, and rx), which is the same as original medicare (aka straight medicare). straight medicare is purely publicly funded by the fed gov’t, while all advantage plans offer the same benefits as original medicare and are paid by medicare for them, except for the extra bonus items the private insurer may include.

    medicare advantage plans are where a private insurer, bcbs, offers a medicare plan which is the same as original medicare, plus they add some special bonuses, like home delivery of meds, or breaks on the cost of deductibles and premiums for both hospital, outpatient, and drugs as they combine some or simply don’t require payment for some. also things like non medical pharmacy items free up to a limit per year that you can order (pepto bismol, allegery meds, teeth care items, aspirin, advil, compresses, bandaging, etc). some may offer any combination of vision, teeth, and hearing benefits as well. because of this type of benefit, it is an ‘advantage’ to most ppl to go with the private insurer offering the medicare plan, so it is medicare advantage. cons include that with a private insurer medicare adv. plan, you must stay in network, etc. but in an advantage plan, there will always be a doc available, who will not refuse medicare coverage.

    private insurers offering medicare ‘advantage’ plans must charge the same for all medicare benefits that original medicare offers. and are reimbursed my medicare at a fixed amount for each insured each month. this means that the extra benefits they may offer are paid for by the private insurer itself. so you get more benefits and medicare pays the private insurer the same amt as if you were on original medicare, and absorbs the costs of the extra benefits offered to you itself.

    Liked by 1 person

    • Thanks so much for the explanation. Makes me wonder how these plans make money, and it explains this:

      “The concerns revolve around the accuracy of a billing tool called a “risk score,” which is supposed to pay insurers higher rates for taking sicker people and less for those with few medical needs. But federal officials have struggled for years to track overspending tied to inflated risk scores.”

      Liked by 1 person

  3. I have a Medicare Advantage Policy through Amerihealth right now. It is a big help in covering what Medicare wouldn’t. I wish I could afford the supplementary policy instead though.

    Liked by 1 person

      • To compare what Tessa pays and what you pay you also need to add the amount if any of your private supplemental policy and your out of pocket costs (and her out of pocket costs of course). If your private supplemental policy is “free” or near free as a result of a retiree benefit, you need to figure some implicit cost to make a fair comparison

        (Also, unless she is on Medicaid, Tessa has to pay the $105 a month Part B premium just like you, assuming that’s what you mean by “$100 every month out of my disability check.”)

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        • I can’t afford the supplemental which almost pays for everything, but the policy cost is around $200 per month. I get eye and dentist through my advantage policy but it is HMO so not many changes and I have lost some of my doctors.

          Liked by 1 person

      • I have extra help from my state. They pay for my part B Medicare and my policy for the extras and prescriptions part D cost me 24.36 because I am eligible for PAAD. Last year that policy as only $3 as Paad helps pay it. My prescription copays for generics are $2.65 per generic and 6.60 for the name brand, but most of them the dr has to show need.

        Liked by 1 person

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