Introduction
Over this past week we published the Medicare Advantage Money Grab investigation, which reveals that billions of tax dollars are wasted every year through leakage of a Medicare payment tool called a “risk score”.
Get involved
If you are a health professional or medical coder and have a story to tell about Medicare Advantage billing issues or “risk scores”, please send Fred Schulte an email.
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If you are a patient in a Medicare Advantage plan and have been scheduled for a “home visit” let us know your opinion.
Was the visit helpful and do you think it will improve your health?
Do you disapprove of the health plan sending someone to your home when you’re not sick?
What we’ve found so far
- Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013 — mostly overbillings — traced to errors with risk scores;
- 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;
- Though federal health officials have recently disclosed billing histories for doctors and other health professionals, key financial records of Medicare Advantage plans have been kept under wraps;
- Medicare Advantage health plans collect billions of dollars from controversial “house calls.” Insurers say the visits improve patient care, but critics argue they inflate costs needlessly;
- The failure to crack down on health plans that overbill doesn’t bode well for the Affordable Care Act, which relies on a similar risk scoring system.
About the series
Center reporters and data analysts spent over a year examining the Medicare payment formula supposed to pay health plans more for sicker patients and less for healthy people, and found that it pays too much. Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013 — mostly overbillings — traced to errors with risk scores.
We also graphed how Medicare Advantage risk scores have changed in more than 14,000 health plans in 3,000 counties nationwide between 2007 and 2011.
CMS officials declined to comment, and refuse to make public specifics on Medicare Advantage plans’ service and billing histories. As a result, the Center filed suit against HHS in U.S. District Court of the District of Columbia in late May.
The series is reported by Center reporter Fred Schulte, with data analysis by David Donald and Erin Durkin, and edited by Gordon Witkin.
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I really appreciate your professional approach. These are pieces of very useful information that will be of great use for me in future.
doctors in San Antonio TX
It’s good to know that private Medicare health plans have caused an increase in the number of doctors performing house calls. My parents are getting old, and they can’t get out of the house very well to go see a doctor whenever something happens to them. I’ll pass this information along to them so that they can look into their options for Medicare plans that include house calls.
This is information that the American public needs to be far more aware of, rather than the daily drama distractions of Washington politics that have no direct effect on most people’s lives. Knowing how medical coverage/billing operates for Medicare provides a much-needed perspective on something that many take for granted — including their assumption that health insurance is a good thing. Tallying the horror stories from all sides of healthcare (patients, medical staff, government payouts to insurance, etc.), only highlights how much better off we all would be WITHOUT insurance interference. The government’s inability to regulate overpayments that they are… Read more »