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By Office of Inspector General and the HHS
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READ REPORT: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp
OIG: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf
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HEALTH INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4
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Filed under: Breaking News, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance | Tagged: HHS, medicare, Medicare Advantage, medicare advantage investigation, Medicare Part C, OIG, Part C, private medicare |
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PART C Positives
https://thehealthcareblog.com/blog/2022/09/02/medicare-advantage-saves-lives-limbs-sight-and-major-amounts-of-money-part-1/
DEM
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DEM
Part 2
https://thehealthcareblog.com/blog/2022/09/06/we-should-channel-people-into-medicare-advantage-plans-where-they-wont-have-amputations-or-go-blind-part-2/
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Related
DEM
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PART C
Part 2
https://thehealthcareblog.com/blog/2022/09/06/we-should-channel-people-into-medicare-advantage-plans-where-they-wont-have-amputations-or-go-blind-part-2/
DEM
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PART C
Medicare Advantage Plans’ deceit is the new game in insurance fraud. Back in 2007 or 2008 Aetna and Cigna were convicted of insurance fraud for not reimbursing their insurers for lab fees that were a covered service. The amount of money that should have been paid to insurers was over a billion dollars for each insurance company. Aetna and Cigna were fined $250,000 each and did not have to compensate the insurers for the money that was inappropriately withheld.
Eddie
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RE: MCR Advantage Plan Audit
From: Dr. Paul Kesselman, DPM
Newly released audits show Medicare Advantage plans overbilled the federal government by millions between 2011 and 2013, with some plans overbilling an average of more than $1,000 per patient per year, Kaiser Health News reported Nov. 21. CMS released the decade-old audits in response to a lawsuit from the news outlet. The 90 plan audits uncovered $12 million in net overpayments for the 18,090 patients sampled. CMS has said it plans to use these error rates to recoup an estimated $650 million in repayments.
Now can you imagine a specialty group of physicians having overbilled Medicare by that amount. How many physicians and administrators would lose their license, go to jail, etc. Where in this story does it indicate the carriers will be subject to False Claims Acts Penalties? That’s the kind of penalty that would cause the UHC CEO to shed a tear!
What more will it take to prove that insurance companies promoting “Advantage” plans are now the wolves guarding the hen house?
Dr. Paul Kesselman, DPM, Oceanside, NY
via: PM magazine
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