PODCAST: Traditional Medicare V. Medicare Advantage

By Eric BrickerMD

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PODCAST: Medicare Advantage Plan Over Payments

A SYNOPSIS

By Eric Bricker

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PODCAST: Government Overpayments to Medicare Advantage Plans are a major problem.

CMS pays Medicare Advantage Plans per member based on a risk score. The more chronic conditions the person has, the larger the payments CMS makes to the Medicare Advantage Plan.

Medicare Advantage Plans may be overexaggerating how sick their members are in order to increase their payments from CMS.

The Department of Justice is currently suing Cigna and Elevance (Anthem) for such over exaggerations.

However there is a deeper problem… CMS itself had performed its own audits, but has not done so in 10 years. CMS identified $650M in overpayments and did nothing about them.

When the Kaiser Family Foundation (KFF) requested information on the audits, CMS refused. KFF had to sue CMS to obtain the audit information and it took 3 years for KFF to win the case.

Perhaps it is incompetence on the part of CMS or perhaps CMS does not want to reveal the audits or do anything about them due to political pressure.

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ORDER: 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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MEDICARE: “Dis” Advantage Plan Marketing

CMS Cracks Down on Medicare Advantage TV Marketing

Dr. David Edward Marcinko MBA

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CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first. The new policy is effective Jan. 1st and was discussed in an Oct. 19th memo from CMS to MA and Part D providers. The agency said it issued the new policy after reviewing thousands of beneficiary complaints regarding confusing, misleading or inaccurate information from plans — plan sponsors are also responsible for all marketing activities from brokers and third-party agencies.

“CMS has conducted so-called ‘secret shopping’ by calling numbers associated with television advertisements, mailings, newspaper advertisements and internet searches to monitor the experience beneficiaries have engaging these entities,” the agency wrote.

“Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision.”

Source: Jakob Emerson, Becker’s Payer Issues [10/27/22]

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OIG: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp

RELATED: https://medicalexecutivepost.com/2021/05/21/podcast-medicare-advantage-plans-insurance-company-goldmine

MORE: https://medicalexecutivepost.com/2022/04/29/probe-medicare-advantage-part-c-plans-deny-needed-care-to-tens-of-thousands-of-patients/

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ORDER: 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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PODCAST: “Signify Health” Start-Up Risk Adjustments [Medicare Advantage Part C]

BY ERIC BRICKER MD

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: The Four [4] Parts of Medicare

UNDERSTAND AND KNOW THE DIFFERENCE: A, B C & D

CITE: https://www.r2library.com/Resource/Title/0826102549

BY MEDICARE – CMS

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