The Biden administration is cracking down on deceptive or misleading Medicare Advantage and drug plan sales tactics. And it's counting on beneficiaries to help catch offenders.
More than half of seniors choose private Medicare Advantage plans instead of traditional Medicare. As rural enrollment increases, many small-town hospitals say that threatens their viability.
Medicare's annual open enrollment period began Oct. 15, allowing seniors to choose new plans. New rules this year are supposed to crack down on misleading marketing but buyers should still beware.
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.