HHS examining risk adjustment practices that led to $12B in Medicare Advantage overpayments

HHS says it's examining risk adjustment practices that may have led to billions in Medicare Advantage overpayments.

HHS Secretary Xavier Becerra said at a March 18 press conference the federal agency is aware of issues surrounding Medicare Advantage beneficiaries being billed for expensive and unnecessary medical services.

"From what I understand and the evidence, the data, it shows that we spend more per Medicare recipient through the Medicare Advantage program than we do through the fee-for-service program for Medicare recipients," Mr. Becerra said. "We have seen some evidence that in certain areas there seems to be charges that go beyond what would be necessary."

A March 15 congressional report from the Medicare Payment Advisory Commission found Medicare Advantage plans received $12 billion in excess payments in 2020. The report says Medicare Advantage risk scores were nearly 10 percent higher than similar fee-for-service Medicare enrollees in 2020 due to higher diagnosis coding intensity.

CMS does reduce Medicare Advantage risk scores to align closer with fee-for-service Medicare scores, but they have never lowered scores further than the minimum required under federal law. 

The agency lowered Medicare Advantage risk scores to 5.9 percent in 2020. The MedPAC report says Medicare Advantage risk scores were about 3.6 percent higher than they would have been if beneficiaries were enrolled in a fee-for-service Medicare plan.

"All those things are being examined," Becerra said. "We don't want anyone overcharging seniors or any other Medicare recipient for services, and we don't want taxpayers to be duped, and so we're going to do everything we can."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Top 40 articles from the past 6 months