Noteworthy News

Government Still Overpaying Medicare Advantage Plans, GAO Says

A new report by the U.S. Government Accountability Office (GAO) concludes that Medicare is overpaying Medicare Advantage plans for the services they provide to their Medicare patients.

According to the GAO study titled CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices, the overpayments occur because insurers are overstating their members’ health problems and receiving larger Medicare payments as a result.  While Medicare has adjusted its Medicare Advantage rates to reflect this upcoding, GAO maintains, the adjustment has only reduced the degree of overpayment and not ended it.

Based on this report, some House members are urging Medicare to increase its cost adjustments to save money.  Such a change could have serious implications for urban safety-net hospitals because of the especially large numbers of Medicare patients they treat.

GAO’s summary of its findings and the complete report can be found hereiStock_000015725011XSmall.

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