Health care findings you may have missed in 2014

Introduction

If you have a loved one in a nursing home, enrolled in Medicare Advantage, or simply want to know how your tax dollars may be misspent, you are probably aware of the Center’s work this year.

If you weren’t aware, you might have missed $70 billion in “improper” Medicare Advantage payments and the problem shared by 80 percent of all nursing homes.

Over the next week or so, we’ll be highlighting our major investigations from 2014 in handy, easy-to-read format. Don’t want to miss out? Sign up and receive them via email.

Today we’re presenting a few of the findings our investigations into America’s health care system have turned up in the past year:

1. $70 billion in ‘improper’ payments

A Center investigation into Medicare Advantage uncovered how $70 billion in “improper” payments have been made to Medicare Advantage plans from 2008 to 2013. Most of these improper payments can be traced back to risk scores, a complicated tool used by the government to pay Medicare Advantage plans higher rates for sicker patients.
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2. Most of that $70 billion is likely gone for good

Federal regulators have kept the results of audits aimed at Medicare Advantage secret, and settlement payments small, even though billions of taxpayer dollars have been misspent on the program. Overpayments related to the “risk score” system are still surrounded by secrecy, despite increased attention to the program and a lawsuit filed by the Center.
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3. Nursing homes report different levels of care to government and consumers

Data provided to consumers through the government-run website Nursing Home Compare over-reports the staffing levels at nursing homes as much as 80 percent of the time. The Center compared the self-reported numbers from Nursing Home Compare to Medicare cost reports, which the Centers for Medicare and Medicaid Services say are more accurate indications of staffing levels, to show which homes advertise one level of care, then provide consumers with very different conditions.
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