View more in

Billions of dollars are being overpaid to Medicare Advantage plans and Medicare recipients are incorrectly labeled “high-risk”
 26 days ago

The federal government has been looking into the Medicare Advantage plans and alleges that many had had overpayments.

42% of Medicare recipients are on the Medicare Advantage plan.

Humana has allegedly claimed patients are sicker than they really are, overcharging the program by $200 million.

Anthem has done the same, receiving an extra $3.4 million for saying patients were high-risk, when they were not.

Aetna has disclosed that HHS OIG was targeting their MA plans in a filing with the Securities and Exchange Commission.

Many individuals on average that are part of the Medicare Advantage plan cost the government around $321 more dollars than anyone in a regular Medicare program.

After analyzing the data, HHS OIG discovered that around 12% of insurers had disproportionally higher payments.

in 2017 the 12%, or 20 insurers, generated half of the $9.2 billion for high-risk payments- yet were responsible for less than one third of Medicare Advantage members.

One company that is not being named and had 40% of the total payments, but had only enrolled 22% of Medicare Advantage workers.

After the unnamed company for highest total payments was UnitedHealthcare, followed by Humana, and then Blue Cross Blue Shield.

Want the latest headlines in your inbox each morning? Click here to sign up for our Morning Edition and Sunday Insight newsletters. They are dedicated to keeping you in the know. You can also download the App for Android (All Android Devices) or iOS (iPhone, iPad)

Comments / 21

Tony Esker
26d ago

get the money back and the ceo goes to jail just like a small pharmacy and pharmacist owner did for making an honest billing mistake

26d ago

I remember when Obamacare was being discussed. I though fix the system before we expand it. They didn’t so we have massive fraud.

dave mitchell
26d ago

those plans are garbage please don't buy a policy go regular Medicare and buy a supplement please


Comments / 0