["Medicare Advantage providers whined for months that they simply
couldnt survive without being able to rip off the government, so the
government said you can rip us off for just a little longer," said one
critic. ]
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BIDEN ADMIN DELAYS MEDICARE ADVANTAGE REFORMS  
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Jake Johnson
April 1, 2023
Commondreams
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_ "Medicare Advantage providers whined for months that they simply
couldn't survive without being able to rip off the government, so the
government said 'you can rip us off for just a little longer,'" said
one critic. _

U.S. Health and Human Services Secretary Xavier Becerra testifies
before the Senate Finance Committee on March 22, 2023 in Washington,
D.C. , Kevin Dietsch/Getty Images

 

The Biden administration announced Friday that it will allow Medicare
Advantage plans to continue overbilling
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the federal government in the short term after the insurance industry
lobbied aggressively
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against proposed rule changes aimed at cracking down on fraud in the
privately run program.

The Centers for Medicare and Medicaid Services (CMS) said
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it is still moving ahead with the changes despite industry pressure to
drop or completely overhaul them.

But instead of implementing the reforms all at once, CMS outlined a
plan
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to phase in the changes over a three-year period, a concession to
large insurers that dominate
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the Medicare Advantage market—which is funded by the federal
government.

"How Washington really works: Medicare Advantage providers whined for
months that they simply couldn't survive without being able to rip off
the government, so the government said 'you can rip us off for just a
little longer,'" _The American Prospect_'s David Dayen tweeted
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the CMS announcement.

The changes
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involve tweaks to the Medicare Advantage risk-adjustment model, which
determines
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how much the federal government pays insurers to cover patient care.

Medicare Advantage plans are notorious for piling on diagnoses
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to make patients appear sicker
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than they are to reap larger payments from the federal government. CMS
estimates
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that overpayments to Medicare Advantage totaled $11.4 billion in
fiscal year 2022, a sizeable drain on the Medicare trust fund.

"Nearly every large insurer in the program has settled or is facing a
federal fraud lawsuit for such conduct," _The New York Times_noted
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Friday. "Evidence of the overpayments has been documented by academic
studies, government watchdog reports, and plan audits."

Mark Miller, the executive vice president of healthcare for the
philanthropy Arnold Ventures, expressed concern
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that the Biden administration's decision to phase the Medicare
Advantage changes in over three years will "continue to reward those
insurers with the most abusive practices over the next two years."

"We are disappointed to hear that reasonable changes targeting abuse
and waste in Medicare Advantage will be phased in over three years
rather than fully implemented immediately," said Miller. "The coding
abuses by insurers in Medicare Advantage have led the independent
Medicare commission (MedPAC), which was created to advise Congress, to
call for a 'major overhaul
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of Medicare Advantage policies."

Medicare Advantage insurers have been fighting
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the Biden administration's proposed changes for months, running ads
warning that the reforms would result in higher premiums and worse
care for patients—claims that federal health officials adamantly
rejected.

_Axios_reported
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that the Better Medicare Alliance, a Medicare Advantage lobbying
group, "has spent $13.5 million on advertising since the beginning of
the year, targeting markets with competitive 2024 Senate races. Their
ads painted the CMS proposal as a cut to Medicare that will eat into
consumer benefits."

But Stacy Sanders, an adviser to Health and Human Services Secretary
Xavier Becerra, told
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the _Times_ last month that "we will not be deterred by industry hacks
and deep-pocketed disinformation campaigns."

Becerra himself pushed back
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media, writing, "Leave it to deep-pocketed insurance companies and
industry front groups to characterize this year's proposed increase in
Medicare Advantage payments as a pay cut."

Biden administration officials sounded a different note on Friday. "We
were really comfortable in our policies, but we always want to hear
what stakeholders have to say," CMS Administrator Chiquita
Brooks-LaSure told the _Times_, admitting that industry lobbying
impacted the agency's decision to drag out its implementation of the
changes.

CMS projected
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Friday that under the finalized rules, Medicare Advantage plans will
see a payment increase of 3.32%—nearly $14 billion—in 2024
compared to this year.

The payment boost will come as Medicare Advantage insurers are facing
growing scrutiny from progressive lawmakers over their business
practices, including widespread overbilling, the use of artificial
intelligence
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off patient care, and denials
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of necessary care.

"Federal audits have found that taxpayers have been overpaying bad
actors running Medicare Advantage plans by billions of dollars every
year, threatening the stability of both Medicare Advantage and
traditional Medicare," Sen. Jeff Merkley (D-Ore.) said
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earlier this week. "This fraud has to end."

Sen. Elizabeth Warren
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joined Merkley last week in criticizing
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massive profits of Medicare Advantage insurers, tweeted
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that CMS is "making progress, but these delays are a step backward."

"For years, private Medicare insurers have been gouging taxpayers and
denying care for seniors and people with disabilities," Warren wrote.
"There is a lot more work to do to curb these abusive practices."

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel
free to republish and share widely.

Jake Johnson is a staff writer for Common Dreams.
 
Common Dreams . To inform. To inspire.To ignite change for the common
good.

* Medicare Advantage
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* Attack on Medicare
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