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Resource ID: #26553
Subject: Medicare
Source: Center for Public Integrity
Affiliation: 
Date: June 4 and June 10, 2014

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Description

This is the first comprehensive effort by a media organization to analyze how government pays for Medicare Advantage, which costs taxpayers some $150 billion a year as it grows explosively. We found that rather than slow health-care spending, as intended, Medicare Advantage plans for the elderly have sharply driven up treatment costs in some parts of the United States—larding on tens of billions of dollars in overcharges and other suspect billings over the past five years alone. The findings are based on an analysis of Medicare Advantage enrollment and billing data as well as thousands of pages of government audits, research papers and other documents, and scores of interviews with industry executives. Our review revealed how an obscure billing formula called a “risk score,” that is supposed to pay Medicare Advantage plans more for sicker patients and less for healthy ones, has been widely abused to inflate Medicare costs.

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