“Federal health officials, citing a need to focus on the COVID-19 pandemic, have temporarily halted some efforts to recover hundreds of millions of dollars in overpayments made to Medicare Advantage health plans.”
“The Centers for Medicare & Medicaid Services says the decision will allow insurers and the agency to ‘focus on patient care,’ and will last ‘until after the public health emergency has ended.’”
“Critics aren’t convinced that’s a wise idea.”
“’Some loosening of regulations during a crisis is necessary. But is this an abdication of oversight?’ asked David Lipschutz, associate director and a senior policy attorney with the Center for Medicare Advocacy. ‘This is a serious concern we will have to grapple with at some point.’”
“Medicare Advantage plans are offered by private health insurers under contracts with Medicare. They treat more than 24 million Americans, most of them seniors at a relatively high risk of serious health complications from the pandemic…”
“In July 2019, Kaiser Health News reported that the government had overpaid Medicare Advantage plans by nearly $30 billion in the past three years alone. In addition, as many as 20 whistleblower lawsuits ― the most recent filed late last month by the Justice Department against industry giant Anthem — have accused health plans of ripping off Medicare by exaggerating how sick their patients were.”
“The coronavirus emergency puts a unique strain on Medicare Advantage plans. Unlike standard Medicare, which pays medical providers for each service they render, Medicare Advantage plans are paid based on the health of members. That means they receive higher rates for sicker patients and less for those in robust health.”
“The insurers assess the health status of each member through face-to-face medical visits, which have been sharply curtailed by the crisis. The industry also argues that during the COVID-19 emergency, health plans and their doctors have little time to process paperwork…” Read the full article here.
Source: Pandemic Delays Federal Probe Into Medicare Advantage Health Plans – By Fred Schulte, April 8, 2020. Kaiser Health News.