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

The Centers for Medicare and Medicaid Services had planned to extrapolate those losses to all affected plan members 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 managed by private insurance companies.

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

Overpayments are reported when patient records do not accurately reflect services paid for by the government or if a patient’s condition does not appear to be as serious as the treatment suggests.

Audit proceedings around the growing Medicare Advantage were secret, so KHN filed a lawsuit to get the results.

“At the end of the day, it was taxpayers’ money that was spent,” David Lipschutz, senior policy attorney at the Center for Medicare Advocacy, told the outlet. “The public deserves more information on this.”