Watchdog Report Sharply Criticizes Fed’s Efforts To Recoup Medicare Advantage Overcharges
The Government Accountability Office said that the Centers for Medicare & Medicaid Services has spent about $117 million on Medicare Advantage overbilling audits, but so far has recouped just $14 million. Meanwhile, some Democrats are speaking up for the Medicare Part B change in the face of intense criticism. Also, fee-for-service payments are published and health systems offset Medicare losses.
NPR/Center for Public Integrity:
GAO Audit: Feds Failed To Rein In Medicare Advantage Overbilling
Private Medicare Advantage plans treating the elderly have overbilled the government by billions of dollars, but rarely been forced to repay the money or face other consequences for their actions, according to a congressional audit released Monday. In a sharply critical report, the Government Accountability Office called for "fundamental improvements" to curb overbilling by the health plans, which are paid more than $160 billion annually. The privately run health plans, an alternative to traditional fee-for-service Medicare, have proven popular with seniors and have enrolled more than 17 million people. The plans, which were the subject of a Center for Public Integrity investigation, also enjoy strong support in Congress. (Schulte, 5/9)
The Hill:
House Dems Defend White House Medicare Drug Pricing Plan
A group of 20 House Democrats is defending a controversial initiative from the Obama administration to change the way Medicare Part B pays for drugs in a bid to combat rising costs. Meanwhile, other Democrats in Congress, including every one on the Senate Finance Committee, have signed letters expressing serious concerns about the proposal. (Sullivan, 5/9)
Modern Healthcare:
Commercial Insurance Margins Offset Rising Medicare Losses
Hospitals in aggregate are expected to post a negative 9% margin on their Medicare business this year, according to a little-publicized report in March from the Medicare Payment Advisory Commission, a group that advises Congress on Medicare rates. In 2014, hospitals posted a negative 5.8% margin on their Medicare business. But for most, they have succeeded in making that up by posting higher margins on their nongovernment reimbursed patients. ... Indeed, as Medicare reimbursement tightened and penalties for readmissions and poor quality kicked into high gear, this cost-shifting grew worse. (Barkholz, 5/7)
