An investigation by the Center for Public Integrity examines how use of a "risk score" that is supposed to help protect the private plans if they have an excess of sicker beneficiaries may have been mishandled.
Center for Public Integrity: Why Medicare Advantage Costs Taxpayers Billions More Than It Should
[Medicare Advantage] plans have sharply driven up costs in many parts of the United States — larding on tens of billions of dollars in overcharges and other suspect billings based in part on inflated assessments of how sick patients are, an investigation by the Center for Public Integrity has found. Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year. ... billions of tax dollars are misspent every year through billing errors linked to a payment tool called a "risk score," which is supposed to pay Medicare Advantage plans higher rates for sicker patients and less for those in good health. Government officials have struggled for years to halt health plans from running up patient risk scores and, in many cases, wresting higher Medicare payments than they deserve, records show (Schulte, Donald and Durkin, 6/4).
The Hill: Feds Overpaid $70B To Medicare Advantage
The federal government wrongfully paid Medicare Advantage programs almost $70 billion, mostly through overbilling between 2008 and 2013, according to a new report. The Center for Public Integrity released the first of its four part investigative series Wednesday on Medicare Advantage payments that examines the use of risk scores used by providers to charge the government more for sicker patients. CPI found between 2007 and 2011, scores for Medicare Advantage patients grew twice as fast when compared to ordinary Medicare patients in more than 500 counties. The report cites government audits of six Medicare Advantage plans in 2007 alone with nearly $650 million in overpayments (Al-Faruque, 6/4).