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Medicare’s Private Plans Canceled By The Government

There have been mounting accusations against those private insurers running Medicare Advantage for overcharging.

Many seniors over the past few years as well as people who are disabled have avoided traditional Medicare coverage and enrolled in private health plans that are paid for by Medicare that have lower out of pocket costs as well as enhanced benefits.

More than 1/3rd of 58 million beneficiaries are now enrolled in the Medicare program in these alleged Medicare Advantage and this grows each month.

There is little that is known about the type of care delivered, how many types of services they get or doctors that treat them and if taxpayer money used is well spent or misused.

Data has been collected by the government on patients diagnoses and services received since 2012 and stated using this last year in an effort to help calculate payments to the private insurers who run the Medicare Advantage plans. Yet this data has never been made public.

The Centers for Medicare and Medicaid Services officials in the recent months have been validating the accuracy of the data and preparing to release this to researchers. Data for Medicare already shares info for 38 million traditional Medicare program patients that the government runs.

The grand unveiling of this new data was to be released at the annual research meeting for Academy Health but was canceled at the last minute. This change caught many off guard, researches as well as former Medicare officials as this data was a highly anticipated expansion by the government’s effort in sharing information.

CMS said too many questions about the accuracy of the data and that it should not be released for used in research. CMS said the data for 2015 will be examined to see if it will be robust enough that it can support research use.

This brought into question the use of data being used for payments yet not used for research.

The halted data was a disappointment to those wanting access as a researcher and as a taxpayer especially in terms of the enormous amount of funds being payed to private insurance companies while knowing very little about what is being received for that money. While claims are being mad about private insurer being more innovated in ways that the traditional program is not, validation is needed to know what is being done to benefit everyone. This cannot be done without the data.

Medicare Advantage plans have been under fire in recent years for allegedly overcharging Medicare. More than 3 dozen audits found with plan overstatements in the severity of enrollees medical conditions in order to garner additional money. This was reported by the Center for Public Integrity. The center had reported insurers between 2008 and 2013 had collected $70 billion in improper health insurance payments.

Two federal lawsuits in Los Angeles were recently intervened by the Department of Justice recently which were accusing UnitedHealth Group of giving inaccurate and untruthful information about the beneficiary’s health status in order boost its revenues which was denied by the company.

Some light could be shed on this if the data for Medicare Advantage plans were made available for these types of issues. It is said that the system used to capture this encounter data has many unresolved issues when it comes to operational and technical gathering failing to capture a comprehensive picture for beneficiaries diagnoses that is reliable as said by a America’s Health Insurance Plans spokeswoman. Stating this could put benefits and payments at risk of being raised or benefits being decreased.