AHL’S TOP STORY: GAO Report Finds as Much as $3.1B in MA Overpayments in 2010
A new Government Accountability Office report found that Medicare Advantage plans in 2010 were overpaid by between $1.2 billion and $3.1 billion, The Hill‘s “Healthwatch” reports (Pecquet, “Healthwatch,” The Hill, 1/26).
[Ed. Note: For background on Medicare Advantage payment rates, click here.]
According to the report, the overpayments resulted from a faulty risk adjustment process that overstated beneficiaries’ sicknesses, which triggered the higher payment rates (Wayne, Bloomberg, 1/27). The report suggests that private insurers are more attentive about noting disease diagnoses that garner higher reimbursements (Sanger-Katz, National Journal, 1/26).
The report, which House Democrats requested, calls on CMS to improve the accuracy of the risk score adjustment by readjusting the diagnostic coding system (Daly, Modern Healthcare, 1/26). The report did not identify plans that received the overpayments, Bloomberg reports (Bloomberg, 1/27).
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