Medicare Advantage Overpayments May Top $3B

Cheryl Clark, for HealthLeaders Media , January 31, 2012

“Unlike the FFS part of Medicare, Medicare Advantage plans work to identify and address beneficiaries' specific health care needs through integrated care coordination, disease management, and quality improvement initiatives.  Recent research has found that these programs are improving the quality of care for seniors in Medicare Advantage compared to FFS," he said in a statement.

"For example, a report in the latest edition of Health Affairs found that seniors with diabetes in a Medicare Advantage special-needs plan had more primary care physician office visits and fewer preventable hospital admissions and readmissions than beneficiaries in FFS.  Conclusions about whether the MA payment system appropriately pays plans should therefore not be based on GAO’s analysis,” Zirkelbach's statement said.

Cosgrove's GAO report also pointed out that CMS's methodology "did not include more current data, did not incorporate the trend of the impact of coding differences over time, and did not account for beneficiary characteristics other than age and mortality, such as sex, health status, Medicaid enrollment status, beneficiary residential location, and whether the original reason for Medicare entitlement was disability."

In 2011, about 11.7 million people—one in four Medicare beneficiaries—was enrolled in a Medicare Advantage plan, Cosgrove said.

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