Watchdog groups to Congress: Crack down on Medicare Advantage plans

At a House committee hearing June 28, oversight officials from across the federal government called on Congress to take action against Medicare Advantage plans found to be denying care to patients while overcharging the government by billions of dollars every year, according to Kaiser Health News.

As Medicare Advantage enrollment continues to grow nationwide, the watchdog groups cited reports of plans denying medically necessary care to members.

The Justice Department is also reportedly pursuing legal action against several Medicare Advantage payers and providers for alleged fraudulent risk adjustment coding practices, where medical records are altered to make patients appear sicker than they actually are.

During the hearing, the oversight groups recommended limits on in-home health assessments because they can overinflate payments and called on CMS to use its existing audit abilities to recoup billions in overpayments to private Medicare Advantage carriers.

An HHS assistant inspector general told the congressional committee that a Medicare Advantage plan denied a medically necessary CT scan for a patient to avoid the possibility of a chronic diagnosis and required an X-ray first, therefore creating a barrier to care.

The acting director of the Government Accountability Office told the committee that seniors with one year or less to live drop out of Medicare Advantage plans at double the rate of other patients.

The director of the Medicare Payment Advisory Commission, an advisory group for Congress, told lawmakers Medicare Advantage "is not meeting" its potential of lowering costs and improving care quality.

CMS Administrator Chiquita Brooks-LaSure was invited to testify but declined to participate in the hearing.

According to Kaiser Health News, lawmakers were unusually critical of Medicare Advantage and its need for improvements but still overwhelmingly support its existence.

AHIP issued a response to the hearing on June 28 that touted the increase in care quality and cost savings that the Medicare Advantage program has provided for millions of patients and committed to working with lawmakers to continue those efforts.

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