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July 2015

Government’s Medical Billing Comes under Scrutiny

Washington Watch

 

After news reports revealed that billions of Medicare dollars have been wasted by overcharging the government for services that didn’t cost as much as they were billed for, two U.S. senators are pushing federal officials to increase oversight of privately-run Medicare Advantage health plans treating seniors.

 

Medicare Advantage programs, the popular private health plans, cover about one in three people eligible for Medicare – at an annual cost topping $150 billion. The alleged fraud, first revealed by whistle-blowers and recent news reports by the non-profit investigative reporting group, the Center for Public Integrity, documented how these private plans have added on billions of dollars in overcharges and other suspect billings based on inflated assessments of how sick patients are.

 

A Government Accountability Office report recently estimated “improper payments to Medicare Advantage plans at more than $12 billion in 2014.” But that’s just the tip of the financial iceberg.

 

Federal officials even acknowledge that they’ve struggled for years to track this overspending since Medicare Advantage was created in 2004. A 2009 Medicare study found that some plans had exaggerated how sick patients were to boost their payments and current of the Centers for Medicare and Medicaid Services (CMS) officials acknowledge that this remains a costly problem.

 

Recently, Sen. Charles Grassley, R-Iowa, who chairs the Senate Aging Committee and Sen. Claire McCaskill, D-Missouri, the committee’s top-ranking Democrat, issued separate calls for action. They are worried about the accuracy of a billing tool called a “risk score” which is intended to pay Medicare Advantage insurers higher rates for taking sicker people and less for those with few medical needs.

 

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Dad's Magical Bracelet

Senior Moments

 

During World War II my father served on the battle damage repair ship USS Ulysses. As a way to earn extra money, and I guess to pass any free time he had, he used to make bracelets for his fellow crewmates out of scrap deck plates from the various ships he worked on. When the war was over, he continued to make bracelets for family and friends. He made two bracelets for me, one when I was a young boy and one when I was older. The latter I have worn every day for almost 50 years.

 

My dad had many wonderful qualities, but the one that shone brightest was his love for children. At his wake, a young man who I knew from our old neighborhood came up to me and said, “I want to tell you a story about your father. You probably don’t remember, but when you and your friends played on your basketball court you wouldn’t let us little kids play with you. When you were finished, your dad would often come out and let us play on the court and he would actually play basketball with us. I will never forget that. He was an amazing man.”

 

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