Humana CEO Signals Industry Plans to Hijack the Medicare for All Movement

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44. How Private Insurers Rip Off Medicare Advantage for Billions of Dollars

http://www.thefiscaltimes.com/2017/05/16/How-Private-Insurers-Rip-Medicare-Advantage-Billions-Dollars

Despite its successes in diversifying government health care coverage for seniors over the past 15 years, the Medicare Advantage managed-care program increasingly has come under attack for excessive and unscrupulous billing practices that are costing taxpayers billions of dollars.

The Government Accountability Office (GAO), the premier non-partisan watchdog, has repeatedly complained of inadequate auditing by the Centers for Medicare & Medicaid Services (CMS) to ferret out wrongdoing or inaccurate billings by scores of for-profit health care insurers that take part in the program.

In 2014, Medicare paid about $160 billion to Medicare Advantage organizations to provide health care services for about 16 million beneficiaries, according to GAO. CMS, which administers the program, estimates that about 9.5 percent of its payments to Medicare Advantage organizations were improper, owing largely to unsupported diagnoses submitted by the private insurers.

That works out to roughly $15.2 billion a year in overbilling or bogus patient diagnoses by the insurance companies providing coverage through health maintenance organizations and other private medical practices.

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