Lawmakers urge 'crack down' on Medicare Advantage payments

A group of lawmakers is urging the Biden administration and Congress to do more to limit Medicare Advantage overpayments, misleading marketing and prior authorization denials. 

Medicare Advantage is "failing both Medicare beneficiaries and taxpayers," Sen. Elizabeth Warren said at a July 26 press conference. 

Ms. Warren, a Massachusetts Democrat, said overpayments to Medicare Advantage plans could exceed $75 billion in 2023. 

Nearly every major insurer has faced allegations of overcharging the government by making patients appear sicker on medical records than they actually are. Payers have largely denied these allegations, saying there has been no purposeful inflation of diagnoses. 

"It is time to crack down on these abuses. Instead of giving away extra money to private insurance companies, we can strengthen traditional Medicare," Ms. Warren said. "By doing that, we can save money, and we can use some of those savings to expand benefits, like hearing, dental and benefits. We can add an out-of-pocket cap for all beneficiaries. We can finally lower the eligibility age for Medicare." 

Rep. Lloyd Doggett, a Texas Democrat, said the Biden administration has made reforms by cracking down on misleading advertisements and proposing prior authorization reforms, but "yielded to insurance lobby pressure" on walking back some stricter proposed overpayment auditing rules. 

"I continue to hear from constituents in Texas who are sick, not only sick healthwise, but they're sick of these misleading advertisements, they're bombarded with marketing calls, and they're shocked when the coverage turns out to be very different from what they were promised," Mr. Doggett said. 

Rep. Mark Pocan, a Wisconsin Democrat, criticized Medicare Advantage plans for prior authorization denial rates.  

"It shows that they're automatically delaying and disapproving care for people who need it," Mr. Pocan said. 

A bill to reform the prior authorization process in Medicare Advantage passed out of the House Ways and Means Committee July 26. 

Mr. Pocan has introduced legislation to prevent private insurers from using Medicare in plan branding. 

"You can have a private health insurance program. You can be Blue Cross Blue Shield Advantage, but you shouldn't be Medicare Advantage, because only Medicare is Medicare," Mr. Pocan said. 

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