WASHINGTON (TNND) — Medicare Advantage, a program designed to offer seniors health insurance through private companies, is facing criticism for allegedly engaging in deceptive practices that could be harming senior healthcare and wasting taxpayer dollars. According to a report discussed by Rachel O’Brien, deputy public policy editor at Open the Books, companies like UnitedHealthCare and Humana are reportedly inflating patients’ risk scores to receive higher reimbursements from the government.
According to a report discussed by Rachel O’Brien, deputy public policy editor at Open the Books, companies like UnitedHealthCare and Humana are reportedly inflating patients’ risk scores to receive higher reimbursements from the government. (TNND)
O’Brien explained that these companies list numerous conditions on patients’ charts to boost their risk scores, resulting in increased government payments. This practice allows Medicare Advantage providers to reimburse doctors about 11% less than traditional Medicare, while pocketing the extra funds. The report highlights that UnitedHealthCare’s risk scores are 37% higher than normal, and Humana’s are 19% higher, leading to significant additional costs for taxpayers.
The federal government is paying UnitedHealthCare $786 more per person and Humana $423 more per person compared to smaller nonprofit companies. Overall, these practices are costing taxpayers an extra $83 billion annually, 22% more than traditional Medicare.
To address these issues, a House bill called the Prompt and Fair Pay Act has been proposed. It aims to require Medicare Advantage plans to reimburse doctors at the same rate as traditional Medicare, potentially reducing the incentive for companies to select patients based on inflated risk scores. However, the current reimbursement disparities have led some health systems to drop Medicare Advantage plans, limiting options for patients.
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The situation underscores the need for legislative action to ensure Medicare Advantage fulfills its original intent of providing seniors with more healthcare options.
