Medicare Advantage

Kaiser Health News has released never-before-seen details of federal audits as the government weighs action against dozens of Medicare Advantage plans.

The rule would ban ads that market plans with confusing words, imagery or logos. The regulation would also prohibit ads that don’t specifically mention a health insurance plan by name.

A KHN investigation found when some Medicare Advantage plans got a rare federal audit, they couldn't produce billing records for care they said they'd provided. Some blamed fire, flood — or doctors.

Taxpayers footed the bill for care that should have cost far less, according to records released under the Freedom of Information Act. The U.S. government may charge insurers $650 million as a result.

The lawsuit was filed by Kaiser Health News three years ago to learn about vast overcharges by the popular health plans that are detailed in audits the government refused to release to the public.

Private Medicare Advantage health plans are increasingly ending coverage for skilled nursing or rehab services before medical providers think patients are healthy enough to go home, doctors and patient advocates say.

The Government Accountability Office and the Health and Human Services inspector general’s office say seniors enrolled in the program are suffering and taxpayers are getting bilked for billions of dollars a year.

Private and public employers are increasingly using the government’s Medicare Advantage program as an alternative to their existing retiree health plan and traditional Medicare coverage. As a result, the federal government is paying the “overwhelming majority” of medical costs, according to an industry analyst.

An alternative to original Medicare, the private plans are run mostly by major insurers. A recent analysis estimates Medicare overpaid these insurers by $106 billion from 2010 through 2019.

TV ads and mailings targeting seniors tout Medicare Advantage plans this time of year, but millions choosing traditional Medicare make a costly and difficult decision about Medigap coverage, which gets much less attention.