HHS inspector general: Still not many Medicare Advantage fraud probes despite big 2007 investigation

Jan 11 2013

HHS says there aren't many investigations into fraud and abuse perpetrated by the nation's Medicare Advantage providers despite recent investigations that concluded four plans got nearly $600 million more in payment than they should have in 2007.

Modern Healthcare: Amid Concerns About Overpayments, HHS Notes Small Number Of Medicare Advantage Probes
HHS' inspector general's office says the $124 billion Medicare Advantage program is the focus of very few investigations from fraud-hunters -- a conclusion that comes on the heels of a string of audits alleging hundreds of millions of dollars of questionable payments in the program. HHS officials last year published the results of long-running investigations into four Medicare Advantage plans, concluding that the plans had received nearly $600 million more than they should have in 2007 by claiming that patients were more medically complex than they were. All four companies denied the allegations, but the inspector general's office is continuing with probes of an untold number of the other 170 or so Medicare Advantage companies working for the CMS (Carlson, 1/10).

Elsewhere, 2013's changes to Medicare are coming into focus --

The Medicare NewsGroup: New Services For Beneficiaries, Tweaked Payment Policies For Providers In 2013
Medicare policy is constantly evolving, and 2013 is no exception. Beneficiaries will see new preventative services, and some providers will see new taxes and others tweaked payment policies. This interactive slideshow highlights many of the latest changes to the program (Sjoerdsma, 1/9).