Jordan Johnson: Medicare Advantage under fire – fraud, overpayments and accountability
Jordan Johnson, Founding Partner of Bridge Oncology and Founder of The Healthcare Hub, shared a post on LinkedIn:
“Medicare Advantage Under Fire: Fraud, Overpayments and Accountability
Medicare Advantage (MA) plans are facing serious scrutiny over allegations of fraudulent upcoding – a practice that inflates patient diagnoses to secure higher government payments. During his Senate confirmation hearing, Dr. Mehmet Oz, nominee for CMS Administrator, called it what it is: CHEATING.
- $40 billion – Estimated excess cost of MA plans due to coding intensity (MedPAC)
- $178 million – Paid for improperly diagnosed diabetic cataracts (Sen. Warren)
- $7.5 billion – Tied to questionable in-home health risk assessments (HHS OIG)
Oz made it clear: ‘There’s a new sheriff in town.’ If confirmed, he vows to tackle these inefficiencies and protect taxpayer dollars.
- But will CMS finally hold insurers accountable?
- Or will powerful industry players continue to fight oversight, as Humana’s legal challenge against a CMS rule to recover $4.7 billion suggests?
MA insurers argue that their plans provide better care at lower costs – but at what price to the integrity of the system?
What do you think? Should CMS crack down on upcoding, or do these risk-adjusted payments genuinely reflect the needs of beneficiaries?”
More posts featuring Jordan Johnson.
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OncoThon 2024, Online
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Global Summit on War & Cancer 2023, Online
Dec. 14-16, 2023