Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday.<\/p>\n

Witnesses sharply criticized the fast-growing health plans at a hearing held by the Energy and Commerce subcommittee on oversight and investigations. They cited a slew of critical audits and other reports that described plans denying access to health care, particularly those with high rates of patients who were disenrolled in their last year of life while likely in poor health and in need of more services.<\/p>\n

Rep. Diana DeGette (D-Colo.), chair of the subcommittee, said seniors should not be \u201crequired to jump through numerous hoops\u201d to gain access to health care.<\/p>\n

The watchdogs also recommended imposing limits on home-based \u201chealth assessments,\u201d arguing these visits can artificially inflate payments to plans without offering patients appropriate care. They also called for the Centers for Medicare & Medicaid Services, or CMS, to revive a foundering audit program that is more than a decade behind in recouping billions<\/a> in suspected overpayments to the health plans, which are run mostly by private insurance companies.<\/p>\n

The health plan required patients to have an X-ray first to prove a CT scan was needed.<\/p>\n

Bliss said seniors \u201cmay not be aware that they may face greater barriers to accessing certain types of health care services in Medicare Advantage than in original Medicare.\u201d<\/p>\n

Leslie Gordon, of the Government Accountability Office, the watchdog arm of Congress, said seniors in their last year of life had dropped out of Medicare Advantage plans at twice the rate of other patients leaving the plans.<\/p>\n

Rep. Frank Pallone Jr. (D-N.J.), who chairs the influential Energy and Commerce Committee, said he was \u201cdeeply concerned\u201d to hear that some patients are facing \u201cunwarranted barriers\u201d to getting care.<\/p>\n

Under original Medicare, patients can see any doctor they want, though they may need to buy a supplemental policy to cover gaps in coverage.<\/p>\n

Medicare Advantage plans accept a set fee from the government for covering a person\u2019s health care. The plans may provide extra benefits, such as dental care, and cost patients less out-of-pocket, though they limit the choice of medical providers as a trade-off.<\/p>\n

Those trade-offs aside, Medicare Advantage is clearly proving attractive to consumers. Enrollment more than doubled<\/a> over the past decade, reaching nearly 27 million people<\/a> in 2021. That\u2019s nearly half of all people on Medicare, a trend many experts predict will accelerate as legions of baby boomers retire.<\/p>\n

James Mathews, who directs the Medicare Payment Advisory Commission, which advises Congress on Medicare policy, said Medicare Advantage could lower costs and improve medical care but \u201cis not meeting this potential\u201d despite its wide acceptance among seniors.<\/p>\n

Notably absent from the hearing witness list was anyone from CMS, which runs the $350 billion-a-year program. The agency took a pass even though committee Republicans invited<\/a> CMS Administrator Chiquita Brooks-LaSure to testify. Rep. Cathy Rodgers (R-Wash.) said she was \u201cdisappointed\u201d CMS had punted, calling it a \u201cmissed opportunity.\u201d<\/p>\n

CMS did not respond to a request for comment in time for publication.<\/p>\n

AHIP, which represents the health insurance industry, released a statement<\/a> that said Medicare Advantage plans \u201cdeliver better service, access to care, and value for nearly 30 million seniors and people with disabilities and for American taxpayers.\u201d<\/p>\n

At Tuesday\u2019s hearing, both Republicans and Democrats stressed a need for improvements to the program while staunchly supporting it. Still, the detail and degree of criticism were unusual.<\/p>\n