The disadvantages of Medicare Advantage programs can extend beyond frustration for patients and lower reimbursement rates for hospitals.
A recent report from the U.S. Health and Human Services Department Office of Inspector General put a sharper focus on questionable practices in certain Medicare Advantage programs from certain commercial health insurance companies. Three health insurance companies were found to have used codes that did not match patient medical records yet secured more than $140 million in federal reimbursements.
From the article:
Humana, HealthAssurance Pennsylvania — a unit of CVS Health subsidiary Aetna — and EmblemHealth deny the accusations and reject the OIG’s recommendations that the Centers for Medicare and Medicaid Services recoup a portion of the alleged overpayments.
According to the OIG reports, the three insurers misused diagnosis codes to generate higher federal reimbursements under the Medicare Advantage risk-adjustment program. The agency:
- Estimates that EmblemHealth received at least $130 million more than it should have in 2015
- Alleges Humana collected at least $13.1 million too much in 2017 and 2018; and
- HealthAssurance received $4.2 million more than they should have in 2018 and 2019.
See what else Groundswell Health is working on in healthcare >>
Elevating Oculus Pathology’s Visibility with Hospital Buyers
OCULUS PATHOLOGY Accelerating Engagement Boosting Oculus Pathology’s Visibility Among Hospital Buyers Website, Digital Targeting, Video
How Smart Marketing Drove Growth and Expanded Access to ABA Therapy
Inner Circle Autism Network Increasing ABA Awareness How Smart Marketing Drove Growth and Expanded Access to ABA
Healthcare costs driving healthcare to top of issues concerning voters
Healthcare Costs Are Back in the Spotlight. Are Hospitals Ready? For months, predictions of increased health insurance premiums have kept
How the History of Snake Oil Teaches us More about Consumers than it Does Fraudsters
... and what Healthcare Marketers Can Learn from them to rebuild trust The term "snake oil salesman" brings to mind
Medicare Advantage Headlines >>
Medicare Advantage Plans Announce Major Lobbying Blitz
As Medicare Advantage plans face myriad challenges, including rising costs, negative media coverage, and increased lawmaker scrutiny, the health insurance
Medicare Advantage Prior Authorization Requests Increase by Nine Million in Three Years
A recent Kaiser Family Foundation analysis found an increase in prior authorization requests from 2019 to 2022, along with a
