Insurers Bilked $50B From Medicare For Dubious Diagnoses, Review Finds
In its analysis of the Medicare Advantage program, The Wall Street Journal looked at details of "doctor visits, hospital stays, prescriptions and other care." Separately, a Stat review has found that more than two dozen Medicare Advantage insurers now qualify for big taxpayer-funded bonuses.
The Wall Street Journal:
Insurers Pocketed $50 Billion From Medicare For Diseases No Doctor Treated
Private insurers involved in the government’s Medicare Advantage program made hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments from 2018 to 2021, including outright wrong ones, a Wall Street Journal analysis of billions of Medicare records found. The questionable diagnoses included some for potentially deadly illnesses, such as AIDS, for which patients received no subsequent care, and for conditions people couldn’t possibly have, the analysis showed. Often, neither the patients nor their doctors had any idea. (Weaver, McGinty, Mathews and Maremont, 7/8)
The Wall Street Journal:
How The Journal Analyzed Medicare Advantage Data
The Wall Street Journal set out to examine the system under which Medicare Advantage insurers can collect extra federal money for patients with certain conditions. The Journal reviewed Medicare data under a research agreement with the federal government. The data doesn’t include patients’ names, but covers details of doctor visits, hospital stays, prescriptions and other care. (Weaver and McGinty, 7/7)
In related news about Social Security fraud investigations —
The Washington Post:
Former Social Security Watchdog Gail Ennis Abused Authority, Report Finds
The Social Security Administration’s recently departed inspector general abused her authority and undermined the integrity of her office while under investigation for misconduct, a report from a committee of federal watchdogs found. Gail Ennis, who left her post last week, repeatedly refused to steer clear of an inquiry into her leadership of an anti-fraud program that issued extraordinary fines on disabled and elderly people accused of disability benefit fraud, investigators found. The report said she obstructed the probe by refusing to be interviewed, ordering subordinates and witnesses to limit access to information, and at times seeking to mislead investigators. (Rein, 7/5)
More Medicare developments —
Stat:
Medicare Advantage Insurers Get Bigger Ratings Bonuses
More than two dozen Medicare Advantage insurers received higher quality marks for 2024, based on a STAT review of new data released July 2 by the federal government. Ten health insurance companies, including UnitedHealth Group’s UnitedHealthcare and CVS Health’s Aetna, received critical upgrades in some of their offerings that will allow them to earn hundreds of millions of dollars in extra taxpayer-funded bonuses. (Herman, 7/3)
The Hill:
White House Explains 'We Finally Beat Medicare' Debate Flub
The White House on Wednesday explained what President Biden meant when he misspoke and said “We finally beat Medicare” in last week’s presidential debate. “He meant to say he beat big pharma,” White House press secretary Karine Jean-Pierre said in a briefing when asked about the president’s words. “I mean, that’s what he meant to say.” (Suter, 7/3)
WCAX:
Feds Approve Vt. Bid To Improve Medicare Affordability, Quality
Vermont is partnering with the federal government and a few other states in a new effort to contain Medicare costs and improve care. The Centers for Medicare & Medicaid Services earlier this week announced it has accepted Vermont’s application to participate in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) program. State officials say the aim is to help bring in more federal Medicare dollars to invest in primary care and preventative medicine to keep people healthy instead of resorting to expensive emergency procedures. (Cutler, 7/5)
