Insurers will fight to protect their Medicare fraud

This year, for the first time, a majority of seniors eligible for Medicare will be on privatized Medicare Advantage plans. Now, the insurance companies raking in giant profits from these for-profit plans are mounting a pressure campaign and planning to sue the government to protect years of overpayments they’ve extracted from Medicare…

What’s more, federal audits have found Medicare Advantage plans systematically overbilling the public — mostly by billing as if patients are sicker than they really are, a scheme known as “upcoding.” Officials estimate the private plans collected $650 million in overpayments from 2011 to 2013…

The Biden administration is expected to finalize a rule next month to try to recoup some of these overpayments — but Medicare Advantage insurers are threatening to sue if the rule moves forward as written, according to Stat News. If insurers sue, it could further delay the government’s efforts to claw back excess payments stretching back more than a decade, as well as future overpayments.

The health insurance industry argues that regulators should allow for some level of payment errors — and should only apply new rules to audits moving forward, instead of retroactively punishing past misconduct.

The stuffed shirts aren’t just worried about their golden goose finally being leaned and cooked. They believe they should be exempt from compensating taxpayers, subscribers, for their earlier thievery. Not a surprise. Not worth condoning either.

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