You’ve heard a lot about Medicare Advantage packages, and now Minnesota’s Congressional Democrats are endorsing those corporate offerings. Naturally, any marketing put forward by the health care insurance industry is going to sound like an advantage, but there are significant factors about those packages which are not being disclosed.
Why is AHIP (America's Health Insurance Plans) thanking 368 members of congress for supporting Medicare Advantage? All ten of Minnesota’s federal officials, both Senators and Congresspersons, signed a letter of support for AHIP supporting Medicare Advantage. This includes Angie Craig, Ilhan Omar, and Dean Philips, all of whom campaigned for progressive health care reform in 2018.
The Medicare Payment Advisory Commission (MedPAC) admits that Medicare Advantage and Medicare’s Accountable Care Organizations (ACOs, which are owned and operated by the insurance corporations) programs are losing money—the funds America’s workers must pay into with each paycheck. MedPAC claims there’s no way to determine why those industry-managed programs are losing our tax money. But I know there is a way, and so do you! Government transparency and accountability! Our government keeps avoiding standards of transparency and accountability—it refuses to operate with normal integrity.
As a citizen, you are entitled to know why Medicare is losing money to Medicare Advantage and ACOs. That’s merely fair. It’s a normal expectation. But corporations are not playing fair; our government does not compel them to follow the law. Since Medicare advantage has captured less than half the market, CMS is now assigning recipients to Direct Contracting Entity (DCE). The DCE is another form of managed care that has clearly failed the American public
Research from the Center for Public Integrity finds that Medicare Advantage plans are clearly gaming the system. This happened to the tune of some $70 billion between 2008-2013 because the insurance industry inflated risk scores. Medicare pays the corporation which offers a Medicare Advantage plan a fixed amount for each individual enrolled. It pays through a tool called a “risk score.” The tool is supposed to pay Medicare Advantage plans higher rates for sicker patients and less for those in good health.
Senator Grassley of Iowa, raised concerns about the Medicare Advantage plans in a letter to The Honorable Seema Verma, Administrator for Centers for Medicare & Medicaid Services (CMS). Senator Grassley reported on a previous response from CMS. He indicated the “Obama Administration failed to mention to the Committee that its initial recovery assessment was $128 million rather than the $3.4 million actually recovered by the government from the five plans. The difference in the assessment and the actual recovery is striking and demands an explanation. Further, in light of the $70 billion in risk score overpayments between 2008-2013 reported by the Center for Public Integrity, CMS’s 2007 overpayment estimate of $128 million appears low and could very well be just the tip of the iceberg.”
The audits disclosing the $128 million in federal overpayments to health plans were part of a cache of confidential CMS documents released through a Freedom of Information Act lawsuit filed by the Center for Public Integrity.
A lack of robust audits and the lack of recovery of overpayments appears to be a chronic problem on the part of our government. The Government Accountability Office (GAO), the watchdog arm of Congress, found that CMS’s methodology for auditing insurance industry contracts with the federal government fails to select those which have the greatest potential for recovery of improper payments. GAO also found that CMS has spent about $117 million on Medicare Advantage audits, but recouped just under $14 million in total.
Quite clearly, CMS is not willing to take on the big offenders. By a similar token, our Congress avoids conflicts with those offenders who pad their campaign coffers. Moreover, 368 Congresspersons signed a letter praising the offenders for their offerings. Don’t expect any meaningful health care reform from Minnesota’s bipartisan delegation any time soon!