Insurers Overcharging Taxpayers For Medicare Advantage, Doctors Allege
The overcharging sum, Physicians for a National Health Program alleges, could be at least $88 billion a year. Meanwhile, Medicare Advantage's predictive AI software is in the spotlight for cutting off care to people who need it. Also: a federal program to cut sepsis deaths, open enrollment, and more.
Medical Economics:
Physician Group Slams Insurers For Overcharging Taxpayers For Medicare Advantage
Medicare Advantage has become a health care “cash cow” for insurance companies even as patient care suffers across the country, according to a new report. Taxpayers are overpaying by at least $88 billion a year for Medicare Advantage (MA), also known as Medicare Part C, the privately administered health insurance program. Depending on the calculations, that overpayment may be as much $140 billion a year, according to “Our Payments Their Profits: Quantifying Overpayments in the Medicare Advantage Program,” published this month by Physicians for a National Health Program. (Payerchin, 10/10)
BenefitsPRO:
Denied By AI: Medicare Advantage's 'Predictive' Software Cuts Off Care, Say Feds
Judith Sullivan was recovering from major surgery at a Connecticut nursing home in March when she got surprising news from her Medicare Advantage plan: It would no longer pay for her care because she was well enough to go home. At the time, she could not walk more than a few feet, even with assistance — let alone manage the stairs to her front door, she said. She still needed help using a colostomy bag following major surgery. (Jaffe, 10/9)
Modern Healthcare:
SCAN, Alignment Tailor Medicare Advantage Plans For Diverse Groups
Medicare Advantage carriers are designing plans for underserved populations that address specific healthcare needs while also finding a way to differentiate their business from competitors. Tailoring Medicare Advantage plans for specific populations is an emerging trend that could become part of these companies' long-term strategies and prompt other industry players to follow suit. (Berryman, 10/10)
KFF Health News:
Feds Hope To Cut Sepsis Deaths By Hitching Medicare Payments To Treatment Stats
Don Smith remembers the moment he awoke in an intensive care unit after 13 days in a medically induced coma. His wife and daughter were at his bedside, and he thought it had been only a day since he arrived at the emergency room with foot pain. Smith said his wife “slowly started filling me in” on the surgery, the coma, the ventilator. The throbbing in his foot had been a signal of a raging problem. (Appleby, 10/11)
Also —
The Philadelphia Inquirer:
Medicare Fall Enrollment For 2024 Starts Oct. 15
Medicare’s fall open enrollment, which runs Oct. 15 through Dec. 7, is an opportunity to review your benefits and make changes for 2024. ... To help make the process easier, The Inquirer has curated a Medicare primer based on questions sent in by readers. Now updated for 2024, it can help you select the best Medicare plan for you. (Gantz, 10/10)
