Medicare Advantage over billed Medicare by allegedly $83 Billion

 

There are accusations that Medicare Advantage plans are overbilling the federal government. Here's a breakdown of the issue:

• The Allegation: Studies suggest Medicare Advantage plans receive 22% more than traditional Medicare for similar beneficiaries. This translates to billions of extra dollars paid by taxpayers.

• Overpayment Estimates: Studies suggest Medicare Advantage plans might be reimbursed at a higher rate than traditional Medicare. A 2023 report by Physicians for a National Health Program estimates this overpayment could be as high as $140 billion annually (https://www.npr.org/sections/health-shots/2022/11/21/1137500875/audit-medicare-advantage-overcharged-medicare). Morningstar puts the figure at $83 billion in 2024 (https://www.morningstar.com/news/marketwatch/2024032679/medicare-advantage-is-overbilling-medicare-by-22).
• Possible Reasons for Overpayment: One reason cited is "upcoding," where diagnoses are inflated to make patients appear sicker and qualify for higher payments. Additionally, since Medicare Advantage uses a different payment structure than traditional Medicare, some argue it incentivizes overbilling.
• Rebuttal Arguments: The Medicare Advantage industry maintains these plans offer efficient care and improve health outcomes for beneficiaries. They argue the higher payments reflect the complexity of managing patient care.
• Policy Debate: The issue of overpayment is being debated by policymakers. Some propose reforms to the payment structure for Medicare Advantage plans.

It's important to consider different perspectives on this complex issue. You can find more information from sources like the Center for Medicare Advocacy and Morningstar articles mentioned earlier.

To explore available plans in your state, visit medicare.gov or contact your local Medicaid office. You may also Click Here and a licensed skilled agent will be in contact to answer any questions you may have.