12/16/2022    Paul Kesselman, DPM

Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers By Millions (Michael M. Rosenblatt, DPM)

Unfortunately, Dr. Rosenblatt is correct. There no
doubt is a two-tiered system of justice in this
country. That does not mean we need to sit back and
accept it as it appears though many consumers and
providers have. Dr. Rosenblatt and his family have
had a similar experience that many of us have had
with insurance companies whether they deal with
long term care, health, life, disability,
homeowners, auto and all the various types of
insurance.

This issue, however, is a bit different. As opposed
to these nefarious practices dealing with
individual consumers who have little practical
recourse, the Part C Medicare Contractors have a
contract and fiduciary duty to report audit results
accurately and not with us individually but with
CMS. This agency has a great deal more teeth to dig
into any one entity no matter they be the “low
lying fruit” providers or megabillion dollar
corporations. It should not matter who the
criminals are should not matter!

From the practical perspective, the OIG and DOJ
will no doubt get more bang for their investigative
buck by pursuing the Advantage Plans than they
would ever get refunded from unscrupulous
providers.

Just think of the feather in the cap of the
investigative team who gets a mega billion-dollar
corporation to admit fraud and pay back hundreds of
millions of dollars to the US Treasury. How would
that infusion improve the future security of the
Medicare Trust Fund?

Hopefully, Congress will get the message that $450M
at a minimum and perhaps billions is nothing to
sneeze at! It should be far easier to get some or
most of that back from US based insurance carriers
than from unscrupulous providers who often hide
their money in unreachable off-shore accounts.

Paul Kesselman, DPM, Oceanside, NY

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