01/17/2023    

MEDICARE NEWS

Most Medicare Advantage Payers Accused of Fraud Allegations or Settled

 

To date, nearly every major insurer has been accused of or settled allegations of Medicare Advantage (MA) fraud from the federal government. Payers have been accused of exploiting the program through elaborate coding schemes that make patients appear sicker on medical records than they actually are — thereby leading to higher payments from CMS. Insurers dispute these claims. MA overpayments to payers are estimated to have cost as much as $25 billion in 2020. 

 

Physicians told The Washington Post in June that it is common practice for payers and health systems to "data mine" a patient's medical history if that individual is covered by MA because the program pays a set amount based on patient risk.

 

Source: Jakob Emerson, Becker’s Payer Issues [1/9/23] via Dr. Seymoure Balaj