AHIP says Medicare Advantage audit reports 'fail to provide context'

AHIP is pushing back on claims that Medicare Advantage plans are overcharging the government. 

In a Nov. 28 press release, the trade association rebutted a Nov. 21 story from Kaiser Health News detailing CMS audits of Medicare Advantage plans conducted between 2011 and 2013. 

The audits showed some plans overbilled an average of more than $1,000 per patient per year. 

CMS released the decade-old audits in response to a lawsuit from the news outlet. 

"Kaiser Health News presents a misleading picture of the program, relying on limited data from long-ago, decade-old audits to make sweeping claims about MA plans that fail to provide context or explain the limits of the data," AHIP said in its statement. 

In the release, AHIP said the CMS audit process relies on physician records and suggested the agency create an "open, transparent and collaborative" process for oversight. 

The association said CMS' review process for records do not always "account for the realities of medical practice." 

"Coding is not an exact science; reasonable, trained professionals can interpret the same medical record in different ways," the trade association said. 

Medicare Advantage has lower payment error rates than traditional Medicare, AHIP added. 

Payers are facing allegations they have exploited Medicare Advantage by making patients appear sicker than they are, thereby receiving more reimbursements from the government. 

Nearly every major payer has been accused of or settled allegations of Medicare Advantage fraud, according to recent reporting from The New York Times.

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