How journalists see Medicare Advantage
You can watch my presentation at the recently concluded Medicare Advantage summit, followed by a panel discussion
I recently had the opportunity to publicly offer a critique of federal overpayments to Medicare Advantage plans and how best to curb those plans’ upcoding abuses. The occasion was the fourth annual Medicare Advantage summit, which brought together a broad cross section of health care policy wonks.
My presentation was followed by a panel discussion with Mark Miller, a columnist for the New York Times and Reuters, whose most recent book is Retirement Reboot: Commonsense Financial Strategies for Getting Back on Track; and Bob Herman, who covers the business of health care for Stat News.
You can view and/or listen to the 45-minute recording of the session by clicking on this link: Is There a Better Way to Curb Upcoding? How journalists view this and other controversies in Medicare Advantage
Stepping forward from this discussion in 2023 to the 2025 Big Bad Billionaire Bill that isn’t even receiving the consideration of such data as this 45 min conversation among highly informed people does, the take I come away with is that we, the American people, as represented by our elected lawmakers would rather cut coverage/access to healthcare for an estimated 14 million people and increase costs of care for vulnerable elderly and disabled people on Medicare and Medicaid, than deal with whining upset insurers who have been granted unearned profits from our tax revenues.
Spot on with focus on Medicare Advantage plans. In addition to higher costs to Medicare they have hidden higher costs to beneficiaries and they keep money for profits by denying or delaying medications and services. Those insurers find their upcoding in various ways. They offer doctors extra money on the side to send them extraneous history and physical reports to try to capture additional diagnoses for complex disease states. They also contract to send physician extenders to patient homes to try to uncover more complex diagnoses, sometimes using inferior tests that generate false positives. Probably there are incentive payments to those ethically compromised providers for adding more disease states to the record. I’ve seen patients who were given inaccurate diagnoses of peripheral arterial disease, atrial fibrillation and retinal disease. This not only frightens patients, but even if those diagnoses are later proven to be false and removed from one EHR of their primary physician, they are still out there forever on others for MAPs to receive higher pay from CMS to manage care that often never results in any additional costs to them. It’s absurd. CMS apparently trusts them more than licensed professionals who prove expertise and accountability in every single encounter and claim. In Alternative Payment Models that were supposed to relieve burdens for primary care, payments for work done for these MAP beneficiaries is still not paid directly to the physician who treated the patient but is passed to the insurer to keep their cut for profit—if they can be induced to participate in the APM at all.