Kaiser Permanente To Pay $556 Million in Record Medicare Advantage Fraud Settlement - KFF Health News

Fascinating that Medicare Advantage a private company healthcare plan rather than a government one where current political banter beats the drum about fraud. So these are private companies committing fraud and not government run plans.

Medicare Advantage plans offer seniors a private alternative to original Medicare. The insurance plans have grown dramatically in recent years and now enroll about 34 million members, more than half of the people eligible for Medicare.

In court filings, the government argued the health plan “pressured” doctors in Colorado and California to add diagnoses “regardless of whether these conditions were actually considered or addressed by the physician during the patient visits,” policies that violated Medicare requirements.

From 2009 through 2018, KP added roughly half a million diagnoses that generated about $1 billion in improper payments to the health plan, according to the complaint.

The KP settlement comes on the heels of a Senate report this month that accused UnitedHealth Group of “gaming” the Medicare Advantage payment system, which is called “risk adjustment.”

“My investigation has shown UnitedHealth Group appears to be gaming the system and abusing the risk adjustment process to turn a steep profit,” Sen. Chuck Grassley (R-Iowa) said in a statement accompanying the report’s release.

The report cited several medical conditions that have repeatedly been linked to overbilling by Medicare Advantage plans, such as coding for opioid dependence disorder in patients who are taking their medications as directed for pain.