![]() Overall, average overpayments to health plans ranged from a low of $10 to a high of $5,888 per patient collected by Touchstone Health HMO, a New York health plan whose contract was terminated "by mutual consent" in 2015, according to CMS records. Unsupported conditions ranged from diabetes to congestive heart failure. ![]() 1 but recently put that decision off until February.īut often medical records supplied by the health plans failed to support those claims. CMS was set to unveil a final extrapolation rule Nov. ![]() Officials at the Centers for Medicare & Medicaid Services have said they intend to extrapolate the payment error rates from those samples across the total membership of each plan - and recoup an estimated $650 million from insurers as a result.īut after nearly a decade, that has yet to happen. Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies. The government's audits uncovered about $12 million in net overpayments for the care of 18,090 patients sampled, though the actual losses to taxpayers are likely much higher. Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by KHN through a three-year Freedom of Information Act lawsuit, which was settled in late September. Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average. Eric Harkleroad/KHN /Getty Images/ Unsplash/ Centers for Medicare & Medicaid Services Data
0 Comments
Leave a Reply. |