New audits show that Medicare Advantage has collected millions in overcharges from patients over a three-year period.
, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.through the lawsuit, shed light on the secretive audit process that Medicare relies on to hold accountable the increasingly popularReacting to the audit findings, Sen. Chuck Grassley called for “aggressive oversight” to recoup overcharges.
When auditors came calling, the previously hidden 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. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments.
The rates of billing codes rejected by auditors varied widely across the 90 audits. The rate of invalid codes topped 80% at Touchstone Health, a defunct New York HMO, according to CMS records. The company also was shown to have the highest average annual overcharges — $5,888 per patient billed to the government.One Medicare Advantage health plan submitted 57 hardship requests, more than any other insurer, though CMS approved only six.
The Medicare Advantage plan issued by Minnesota Blue Cross won its appeal after it relied on Aggeus Healthcare for diagnoses of vascular disease for 11 of its patients who got podiatry care.
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