President Obama’s proposed 2016 budget takes a major swipe at waste and abuse in Medicare Advantage plans for the elderly, seeking more than $36 billion in cuts over the next decade to curb costly government overpayments to the industry.
The cuts are spelled out in the more than $1 trillion budget proposal to fund the giant Department of Health and Human Services. HHS includes the Centers for Medicare and Medicaid Services, which oversees the privately-run Medicare Advantage plans that now provide health insurance to more than 16 million seniors.
The White House is focusing its budget scalpel on mounting concerns that some health plans exaggerate how sick their patients are to overcharge the government — the subject of a recent Center for Public Integrity investigation.
The White House budget, released on Monday, brought a quick retort from the Better Medicare Alliance, a group formed late in 2014 to advocate for Medicare Advantage plans.
“Medicare Advantage has been subject to billions in real cuts for each of the last four years. These annual cuts have resulted in higher out-of-pocket costs and lost benefits for seniors across America," the group’s interim executive director, Krista Drobac, wrote in a statement.
“Piling on billions more cuts will only do more harm to the 16 millions of seniors who count on Medicare Advantage for higher quality, more affordable health coverage,” wrote Drobac, a veteran health care lobbyist.
Unlike standard Medicare, in which doctors and hospitals bill for each service they provide, private Medicare Advantage plans and other managed care organizations are often paid a flat monthly rate for each patient using a formula called a “risk score” that estimates the health challenges facing individual patients.
Basically, Medicare pays higher rates for sicker patients and less for people judged to be in good health.
But federal officials concede that billions of tax dollars are misspent every year because some Medicare health plans exaggerate how sick their patients are, a practice known as “upcoding.”
Copyright 2014 The Center for Public Integrity. This story was published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.