A KHN investigation found when some Medicare Advantage plans got a rare federal audit, they couldn't produce billing records for care they said they'd provided. Some blamed fire, flood — or doctors.
Taxpayers footed the bill for care that should have cost far less, according to records released under the Freedom of Information Act. The U.S. government may charge insurers $650 million as a result.
An alternative to original Medicare, the private plans are run mostly by major insurers. A recent analysis estimates Medicare overpaid these insurers by $106 billion from 2010 through 2019.
In a civil suit filed this week, the Justice Department accuses a New York medical analytics company of helping a Medicare Advantage plan cheat taxpayers out of millions of dollars.
If the report by the U.S. Department of Health and Human Services' Office of Inspector General is sustained, Humana Inc. could face a record penalty for overcharges in a Medicare Advantage plan.