Uncovered audits show rampant overpayments in Medicare Advantage

Government payments to Medicare Advantage plans are riddled with overcharges and errors, newly uncovered audits show.

A sampling of billings in 2011-2013 showed $12 million in net overpayments for about 18,000 patients, according to the audits obtained by Kaiser Health News through a lawsuit.

The Centers for Medicare and Medicaid Services had planned to extrapolate those losses to all members of the impacted plans and recover $650 million. But that hasn’t happened yet because the calculations haven’t been finalized, Kaiser Health News (KHN) reported.

Medicare Advantage is an alternative to traditional Medicare that is run by private insurance companies.

Seventy-one of the 90 audits reviewed by KHN showed overpayments and they topped $1,000 per patient on 23 of the audits.

Overpayments are flagged when patient records don’t adequately reflect services the government paid for, or if a patient’s condition doesn’t appear to be as severe as the treatment suggests.

Audit procedures around Medicare Advantage, which is growing in popularity, have been secretive so KHN sued to obtain the results.

“At the end of the day, it’s taxpayer dollars that were spent,” David Lipschutz, a senior policy attorney with the Center for Medicare Advocacy, told the news outlet. “The public deserves more information about that.”