‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

Medicare Advantage Plans are committing fraud.



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Thanks for this link. I’ve seen this posted in multiple places but couldn’t be bothered with circumventing the paywall. It’s worth a read in full and a “think about”

FWIW, this isn’t an issue that’s confined to Medicare Advantage plans…although I can see why these would be the biggest facilitators of the abuse. Overcoding can…and does…occur with traditional Medicare plans as well as regular employer provided group plans. I’ve addressed this problem indirectly on both the Health Related Finances, the LBYM and METAR boards (the thread will be easiest to find on the HRF board)

As I mentioned on one of those boards …I think, the HRF…Medicare beneficiaries (especially Advantage members) are most likely to be unwittingly enabling this practice unless they have a patient portal where they can scrutinise their listed medical diagnoses as the no charge, no paperwork promise doesn’t raise any red flags.

The practical problem for the individual is that, if those medical records ever need to be accessed by a third party…for a Medicare supplemental insurance, for instance…those erroneous diagnoses can make a big impact on premiums and take a lot of fighting after the fact.

As usual, there are 3 sides to every story and the nuances of how this can happen are a bit more subtle than NYT’s headlines and reporting suggest.

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