Released: December 19, 2022

How Medicare Advantage plans overcharged taxpayers by millions

Source: Fred Schulte & Holly Hacker, NPR

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people.

When auditors came calling, the previously hidden Center for Medicare and Medicaid Service (CMS) records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes or vascular disease.

Payment errors continue to be a drain on the government program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses at $11.4 billion for 2022.

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