A NEW MEDICARE REGULATION WILL AGGRESSIVELY
AUDIT ADVANTAGE PLANS FOR INDICATIONS OF OVERBILLING
THE BIDEN ADMINISTRATION HAS ANNOUNCED A NEW
RULE DESIGNED TO CRACK DOWN IN MEDICARE PRIVATE
PLANS THAT HAVE ALLOWED INSURANCE COMPANIES TO
OVERCHARGE THE U. S. GOVERNMENT.
THE REGULATION IS SEEKING A MORE AGGRESSIVE
APPROACH TO AUDITING THE MEDICARE ADVANTAGE PROGRAMS
PLANS.
THE MEDICARE ADVANTAGE PROGRAM ENROLLS
ALMOST 50% OF ALL THE BENEFICIARIES
OF MEDICARE. ACCORDING TO THE BIDEN
ADMINISTRATION, IT IS EXPECTING TO RECOUP
AS MUCH AS $4.7 BILLION
FROM INSURANCE COMPANIES THAT HAVE OVERCHARGED THE
FEDERAL GOVERNMENT OVER THE LAST 10 YEARS.
THIS NEW OVERSIGHT IS ALSO EXPECTED TO ACT
AS A DETERRENT AGAINST FUTURE OVERPAYMENTS.
THIS REPRESENTS THE STRONGEST ACTION THE US
GOVERNMENT HAS TAKEN AGAINST OVERBILLING IN OVER 10
YEARS. THE NEW RULE PROVIDES THE
GOVERNMENT WITH THE ABILITY TO CONDUCT A MORE THOROUGH
AUDIT, AFTER WHICH IT CAN RECOVER FUNDS FROM
OVERPAYMENTS.
MEDICARE HAS FACED HEAVY CRITICISM FOR
FAILING TO DEFEND ITSELF FROM OVERCHARGES
FROM INSURANCE COMPANIES.
HEALTH AND HUMAN SERVICES SECRETARY XAVIER
BECERRA ANNOUNCED THE CHANGE AT A NEWS CONFERENCE
THERE
ACKNOWLEDGED THAT MEDICARE HAS EXPERIENCED
CONSIDERABLE CRITICISM FOR ITS WEAK STANCE
AGAINST THE ONGOING ISSUE OF OVERCHARGING PLANS.
TODAY, WE ARE TAKING SOME LONG OVERDUE
STEPS TO MOVE US IN THE DIRECTION OF ACCOUNTABILITY,
SAID VISCERA AT THE CONFERENCE,
MEDICARE ADVANTAGE HAS BEEN GROWING
IN POPULARITY IN RECENT YEARS, PARTICULARLY
AMONG OLDER AMERICANS SAID VISCERA.
AS A RESULT, HE SAID, IT IS IMPORTANT FOR
THE AGENCY TO BE CERTAIN THAT THE PRIVATE PLANS
HAVE PROPER OVERSIGHT. WE WANT TO ENCOURAGE
CORRECT REPORTING ACROSS THE PROGRAM.
HEALTH INSURANCE COMPANIES HAVE BEEN HEAVILY
LOBBYING AGAINST THE RULES POLICIES AS
THEY RELATE TO A RISK ADJUSTMENT SYSTEM.
THEREFORE, IT IS EXPECTED THAT INSURERS
WILL BE FILING LEGAL ACTIONS AGAINST THE FEDERAL
GOVERNMENT TO FIGHT THE CHANGE THE SARAH
STATE, THAT HE WOULD NOT BE ABLE TO SPECULATE ON THE SIZE
OR NATURE OF ANY POSSIBLE LITIGATION, BUT
HE UNDERSCORED THAT HE FELT THAT THE NEWLY ANNOUNCED
RULE WAS READY FOR PRIME TIME.
THIS RULE IS UNLAWFUL AND FATALLY FLAWED
AND IT SHOULD HAVE BEEN WITHDRAWN INSTEAD OF FINALIZED,
SAID LARGE INSURER TRADE GROUP OF HIPS PRESIDENT
MATT EYLES IN A PREPARED STATEMENT. THANK
YOU FOR WATCHING. WE KNOW YOU WANT MORE.
JUST HIT SUBSCRIBE AND SIGN UP FOR OUR WEEKLY
NEWSLETTER TODAY. WE'D ALSO LOVE TO
HEAR FROM YOU. PLEASE LET US KNOW.