How Medicare Advantage plans dodged auditors and overcharged taxpayers by millions,” by Fred Schulte and Holly k. Hacker, NPR


“A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that Blue Cross and a number of other health insurers issuing Medicare Advantage plans have tried to sidestep regulations requiring them to document medical conditions the government paid them to treat. The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013. As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.”


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

Government health programs like Medicare and Medicaid are rife with error because no one has a profit motive to find and eliminate error. Introducing a private sector component as in Medicare Advantage likely mitigates that problem, but introduces another one, cronyism. The best way to reduce error in the health care system is a free market in which providers compete, independent monitors evaluate quality and patients choose winners by spending their own or their insurer’s money.