The plans use "risk scores," a payment tool "which is supposed to pay Medicare Advantage plans higher rates for sicker patients and less for those in good health." This investigation uncovered a lot of questions about how these risk scores are being used, and how much federal money is being paid out on these errors.
Among the findings:It'll be interesting to see if the Republican deficit hawks decide to deal with that, the end result of an experiment in privatizing Medicare. CPI tried to determine which insurance companies overbilled, but "officials who run the Medicare program repeatedly refused to be interviewed or answer written questions." The organization has filed a lawsuit to make that information public.
- Risk score errors triggered nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013—mostly overbillings, according to government estimates. Federal officials refused to identify health plans suspected of overcharging Medicare, citing agency policy that keeps many business records confidential. The Center is suing to make these records public.
- Risk scores of Medicare Advantage patients rose sharply in plans in at least 1,000 counties nationwide between 2007 and 2011, boosting taxpayer costs by more than $36 billion over estimated costs for caring for patients in standard Medicare.
- In more than 200 of these counties, the cost of some Medicare Advantage plans was at least 25 percent higher than the cost of providing standard Medicare coverage. The wide swing in costs was most evident in five states: South Dakota, New Mexico, Colorado, Texas and Arkansas.