Medicare Advantage plans took millions from the US government and aren't required to pay it back: report

31 January 2023

A new report is shedding light on the tactics used by Medicare Advantage plans to overcharge the U.S. government for senior-citizen memberships. But despite receiving multi-millions in overage charges, these entities are still holding on to the funds, according to The Chicago Sun-Times.

"Medicare Advantage plans for seniors have dodged a major financial hit as federal officials decided to give them a reprieve on returning hundreds of millions of dollars or more in government overpayments — some dating back a decade or more," the report reads.

Although there have been concerns about the healthcare insurance industry having to pay back millions in funds dating back more than a decade, the news outlet is reporting that the federal Centers for Medicare & Medicaid Services (CMS) announced it would require little to nothing to be paid back through 2017.

The report also highlights how Medicare Advantage agencies stand to benefit from this announcement in the future.

"The decision ultimately could cost Medicare Advantage plans billions of dollars in the future, but it will be years before any penalty comes due," the report notes. "And health plans will be allowed to pocket hundreds of millions of dollars in overcharges and possibly much more for audits before 2018. Exactly how much isn’t clear because audits as far back as 2011 have yet to be completed."

Amid the latest reports, health industry officials are expressing concern and calling for accountability measures to be put in place.

U.S. Department of Health and Human Services Secretary Xavier Becerra argues that the rule takes “long-overdue steps to move in the direction of accountability.”

David Lipschutz, a lawyer with the Center for Medicare Advocacy, also weighed in saying, “It is our hope that CMS would use everything within their discretion to recoup overpayments made to Medicare Advantage plans.” However, he also noted, “It is unclear if they are using all of their authority.”

The Chicago Sun-Times' full report is available at this link.

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