Medi-scam at Medicare Advantage? Insurers Accused of Gaming the System — Physician’s First Watch

Medical News |
May 17, 2017

Medi-scam at Medicare Advantage? Insurers Accused of Gaming the System

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

UnitedHealth Group and other insurance companies stand accused of "systematically bilking" Medicare Advantage of billions of dollars annually, the New York Times reports. The scheme echoes earlier accounts of clinicians' overbilling by "code creep."

The accusation comes from a whistle-blower, a former finance director at UnitedHealth. He told the Times that the company uses data-mining to find ways to increase the apparent seriousness of patients' illnesses — and thus Medicare's payments to the insurer. UnitedHealth denies the allegation.

The article points out that data-mining teams meeting the added revenue targets received bonuses, but there were none for better health outcomes.

Recovering any of the $70 billion estimated to have been overpaid to insurers between 2008 and 2013 alone likely won't be a simple matter. An attempt to collect $128 million from insurers back in 2007 netted the government a mere $3.4 million.

Reader Comments (1)

Tina Dobsevage, MD, FACP Physician, Internal Medicine, United States

This bilking of the government by Medicare Advantage plans has been known for years. In addition, patients are often enrolled in these plans without their permission. What we need is publicly funded health care, an Improved Medicare for all.

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