Government Overpayments of Medicare Advantage Plans


A series of recent audits have revealed a concerning trend in the way that Medicare Advantage plans have been receiving payments from the government. According to reports, a sampling of billings showed nearly $12 million in net overpayments for about 18,000 patients between 2011 and 2013.

The Centers for Medicare and Medicaid Services (CMS) had planned to extrapolate these losses to all members of the impacted plans and recover around $650 million – yet this hasn’t happened yet as the calculations are still being finalized.

Did Medicare Advantage Providers Cheat The System?

The CMS has noted that much of this problem comes down to errors with coding and billing practices by private insurers who are contracted to manage Medicare plans for seniors on behalf of the government. That said, it could be argued that the CMS is also at least partially responsible for this situation due to its failure to properly monitor how private insurers were managing their accounts.

Many seniors may find themselves wondering why they haven’t received proper refunds or compensation if their plan was among those overcharged.

What Is Being Done To Prevent Overpayments In The Future?

At present, it is unclear exactly what kind of action will be taken by the CMS in order to address these overpayments. However, it is likely that some form of reimbursement will eventually be provided but until then, many seniors are concerned about how much money they may have lost out on due to these errors.

This news has fortified distrust toward private insurance companies which could lead seniors to become more skeptical when signing up for Medicare plans in the future.

It’s understandable why so many senior citizens and baby boomers feel frustrated about this news – especially given how important it is for them to get access to quality healthcare services during retirement age.

At present, it remains uncertain exactly how much money was lost through these mistakes but hopefully, the CMS will take swift action in order to provide any overdue refunds as soon as possible.

In any case, this incident serves as an important reminder that people should always carefully review their statements when signing up for new healthcare plans in order to ensure accuracy and fairness at all times.