Government overpays Medicare Advantage plans, report says

Wednesday, June 4, 2014

WASHINGTON – The federal government overpaid nearly $70 billion to Medicare Advantage (MA) plans between 2008 and 2013, according to a new report from the Center for Public Integrity (CPI).

CPI found that the risk scores used by providers to charge the government more for sicker patients rose sharply in MA plans in at least 1,000 counties between 2007 and 2011, boosting taxpayer costs by more than $36 billion over the estimated costs for caring for patients in standard Medicare.

“In more than 200 of these counties, the cost of some MA plans was at least 25% higher than the cost of providing standard Medicare coverage,” the report states. “The wide swing in costs was most evident in five states: South Dakota, New Mexico, Colorado, Texas and Arkansas.”

Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year, according to CPI.

The report is the first in a four part series. CPI is suing CMS to release copies of program audits, billing data and the identities of plans suspected of overcharging the government.



I hope they are successful in getting CMS to release the records. I don't understand why they shouldn't be readily available under the FOIA. Something smells fishy, as usual.