“…A year-long investigation by the Center for Public Integrity has revealed that health insurers may have fleeced taxpayers out of $70 billion in just five years. You would think members of Congress in both parties would be so outraged they’d be launching their own investigation and railing against the ‘fraud and abuse’ they decry on the campaign trail…
- Federal officials made nearly $70 billion in ‘improper’ payments to Medicare Advantage plans from 2008 to 2013, mostly overbillings, by manipulating or misusing a Medicare payment tool called a ‘risk score’;
- From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for people in standard Medicare in more than 500 counties nationwide;
- Federal health officials have long kept key financial records of Medicare Advantage plans in a ‘black box,’ inaccessible to the public and press;
- Medicare Advantage health plans collect billions of dollars from controversial ‘house calls’ that industry officials say help improve care but which critics argue inflate costs needlessly.
“…Wall Street financial analysts devote considerable attention to determining how much insurers’ Medicare Advantage business contributes to their bottom lines and how much of the money they take in from the government is actually paid out in medical claims. The less they spend on medical care, the better, from Wall Street’s perspective.