Report: Medicare Plans Overbilled $70B

Jun 5, 2014

A new investigation alleges the federal government improperly paid nearly $70 billion in Medicare Advantage charges between 2008 and 2013.

The Center for Public Integrity analysis found that many health plans in Florida and other states were increasingly likely to link Medicare Advantage policy holders to higher “risk scores,” a complicated calculation that results in larger payments.

Risk scores have been used since 2004 to pay health plans for treating seniors with Medicare Advantage plans. In general, the scores pay more for sicker patients and less for people needing less medical treatment.

Using government data, CPI reporters identified nearly $70 billion in “improper payments” from the Centers for Medicare & Medicaid Services. While officials identified significant billing mistakes, they refused to identify the health plans suspected of doing so, CPI reported.

The analysis also found that Medicare Advantage plans also usually receive more money than ones under traditional Medicare, the investigation reports.

The first of the three-part investigation was published this week, and charts 5,700 health plans in 3,000 counties across the country.  Check out Florida trends, broken down by health plan and county here.