“Diane Archer on the Medicare Advantage Racket,” by Editor, Corporate Crime Reporter

“In September 2018, a government report was released and was largely ignored by the mainstream press. The report from the Inspector General at the Department of Health and Human Services (HHS) seductively titled – Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials – found that Medicare Advantage regularly denies claims and that when patients appeal those denials, the Medicare Advantage plan reversed three-quarters of their own denials. The numbers were troubling because of the infrequency with which patients and providers used the appeals process – just one percent of those denied care.”

 

LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:

 I think the proportion of denial reversals is similar for traditional Medicare. But I’m not sure about the percentage of denials that are appealed. One percent appealed with 75 percent of those reversed for Medicare Advantage does sound out of line. Lesson learned: always appeal every Medicare denial.