If You Have a Medicare Advantage Plan, Please Read This

I am outraged at an article in the New York Times yesterday of how Medicare Advantage Plans manufactured and found other ways of altering a patient's medical record to bill more to Medicare for diseased patients.

Whistleblowers from UnitedHealth Group and other insurers told the Justice Department that Advantage insurers asked doctors to find more illnesses in medical records, even though those patients were not getting care. Yet, the doctor would get paid more and the insurer would bill Medicare more. The article noted that Billions of dollars were billed to Medicare by inflating bills of sicker patients and this has been going on for years.

According to the complaint, eight of the 10 largest Advantage Plans submit larger bills for newfound diseases, according to federal audits. Medicare spends more on Advantage Plan members than the Army and Navy combined. In 2020, Advantage Plans gained enough money to fund hearing aides and vision care for every person over 65 years old. The amount of money they took in exceeded $12 billion! 

Nearly all Advantage Plans have been accused of Overbilling. Here's a list of plans that have also been accused of fraud, fraud by the U.S. Govt, accused of failing to remove diagnoses, Paying doctors and nurses for finding more diagnoses, 

1. Unitedhealth Group: with 21.7% of the market.

2. CVS Health: with10.7% of the market, Wasn't accused of fraud by US govt., but was accused of everything else.

3. Kaiser Permanente: 6.1% of market. Wasn't accused of overbilling by US Govt, but was accused of everything else.

4. Elevance Health: 6.5% of market. Only accused of overbilling according to Inspector General

5. Centene: 5% of market and not accused of anything

6. Blue Cross Blue Shield of Michigan: 2.2% of market. Just accused of overbilling by Inspector General

7. Cigna: 1.9% of market. Accused of everything, except, failing to remove inaccurate diagnoses and didn't pay doctors or nurses more to add diagnoses

8. Highmark: 1.3% of market. Only accused of overbilling by Inspector General

9. Scan Group: 0.9% of market. Accused of everything except, didn't pay doctors and nurses more to diagnoses diseases.

Ask to view your medical record and let your doctor know if you see made-up diseases.

Always, contact Health Advocate Experts, if you need assistance.

We are here to help you!