Six things to know:
1. Whistleblowers have alleged payers are inflating how sick their members appeared to be to get higher payments from Medicare. Whistleblowers have filed their initial complaints under seal to give the government time to investigate and decide whether to proceed. The process can take years.
2. The Justice Department has called policing Medicare Advantage a priority for its anti-fraud agenda.
3. UnitedHealth, Anthem, Cigna and Kaiser Permanente are fighting lawsuits, each denying claims of wrongdoing.
4. The Medicare Payment Advisory Commission said in March that coding differences brought Medicare Advantage plans $12 billion in excess payments in 2020 over what traditional Medicare would have paid to cover the same population.
5. Medicare Advantage’s hospital trust fund is projected to be depleted in 2026, according to the Kaiser Family Foundation, which has no affiliation with Kaiser Permanente.
6. Payers have said Medicare Advantage is a win-win. The program caps members’ out-of-pocket costs and offers benefits traditional Medicare does not.
Read the full Bloomberg article here.
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