{"id":3335,"date":"2024-09-30T10:30:35","date_gmt":"2024-09-30T10:30:35","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=3335"},"modified":"2024-09-30T10:30:37","modified_gmt":"2024-09-30T10:30:37","slug":"the-medicare-advantage-influence-machine","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=3335","title":{"rendered":"The Medicare Advantage Influence Machine"},"content":{"rendered":"
\n

Federal officials resolved more than a decade ago to crack down on whopping government overpayments to private Medicare Advantage health insurance plans, which were siphoning off billions of tax dollars every year.<\/p>\n

But Centers for Medicare & Medicaid Services officials have yet to demand any refunds \u2014 and over the years the private insurance plans have morphed into a politically potent juggernaut that has signed up more than 33 million seniors and is aggressively lobbying to stave off cuts.<\/p>\n

Critics have watched with alarm as the industry has managed to deflate or deflect financial penalties and steadily gain clout in Washington through political contributions; television advertising, including a 2023 Super Bowl feature; and other activities, including mobilizing seniors. There\u2019s also a revolving door, in which senior CMS personnel have cycled out of government to take jobs tied to the Medicare Advantage industry and then returned to the agency.<\/p>\n

Sen. Chuck Grassley (R-Iowa) said Medicare Advantage fraud \u201cis wasting taxpayer dollars to the tune of billions.\u201d<\/p>\n

\u201cThe question is, what\u2019s CMS doing about it? The agency must tighten up its controls and work with the Justice Department to prosecute and recover improper payments,\u201d Grassley said in a statement to KFF Health News. \u201cClearly that\u2019s not happening, at least to the extent it should be.\u201d<\/p>\n

David Lipschutz, an attorney with the Center for Medicare Advocacy, a nonprofit public interest law firm, said policymakers have an unsettling history of yielding to industry pressure. \u201cThe health plans throw a temper tantrum and then CMS will back off,\u201d he said.<\/p>\n

Government spending on Medicare Advantage, which is dominated by big health insurance companies, is expected to hit $462 billion<\/a> this year.<\/p>\n

New details of the government\u2019s failure to rein in Medicare Advantage overcharges are emerging from a Department of Justice civil fraud case<\/a> filed in 2017 against UnitedHealth Group, the insurer with the most Medicare Advantage enrollees. The case is pending in Los Angeles. The DOJ has accused the giant insurer of cheating Medicare out of more than $2 billion by mining patient records to find additional diagnoses that added revenue while ignoring overcharges that might have reduced bills. The company denies the allegations and has filed a motion for summary judgment<\/a>.<\/p>\n

Records from the court case are surfacing as the Medicare Advantage industry ramps up spending on lobbying and public relations campaigns to counter mounting criticism.<\/p>\n

\n\t