#health + #healthcare

In 2019, differences in diagnostic coding caused Medicare to pay MA plans $9 billion more than it would have spent if the same beneficiaries had been enrolled in FFS Medicare.

Excess payments to MA plans may benefit enrollees in the MA program (when used to increase the value of extra benefits offered rather than increase profits) but cost taxpayers more than if these enrollees were covered in FFS Medicare. Further, excess payments to MA plans increase fiscal pressure on the Hospital Insurance (Part A) Trust Fund as well as on the taxpayers, beneficiaries, and state Medicaid programs who pay premiums to finance the Part B program.

The Medicare Payment Advisory Commission We are a nonpartisan independent legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program.

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.

The measles, mumps and rubella vaccine is safe and provides 97% protection against the disease after two doses. Most children in the U.S. are required to get the shot to attend school. But vaccination rates have declined as more parents waive the shots or have fallen behind on recommended vaccination schedules.