$2.4 Million In Medicare Parts A & B Payments Made To Dead People

freebeacon
BY: Ali Meyer
October 19, 2017 11:30 am

Agency has not yet recouped millions in improper payments

The Centers for Medicare and Medicaid Services made $2.4 million in Medicare Parts A and B payments after beneficiaries died, according to an audit from the Department of Health and Human Services Office of Inspector General.

The agency is required to implement policies to prevent beneficiary payments from being made to deceased individuals and should ensure that improper payments are recouped if they are made.

"Our objective was to determine whether CMS's policies and procedures ensured that capitation payments were not made to MA [Medicare Advantage] organizations for Medicare Parts A and B services on behalf of deceased beneficiaries after the individuals' dates of death," the auditors said.

While auditors found that the agency generally had procedures in place to ensure payments were not made to dead people, they found that the agency did not recoup all of the improper payments. Auditors found that as of March 2017 the agency did not recoup $2,420,761 made to 978 dead beneficiaries.

The agency makes monthly capitation payments to MA organizations, which use the payments to cover Medicare Parts A and B services beneficiaries would normally need.

"At the beginning of each month, CMS makes a capitation payment to each MA organization to cover any medical services provided to each beneficiary in that month," auditors explain. "If CMS receives changes to beneficiary information that would alter previous monthly payments, it adjusts the applicable capitation payment."

"Such adjustments are processed retroactively to the effective date of the change and reported to the MA organizations on monthly payment reports," the auditors said.

The report found that the agency's data systems were generally effective in signaling when a beneficiary had died so that improper payments were not made.

"When CMS receives information about a beneficiary's death, CMS enters the date of death into its data systems and disenrolls the beneficiary," said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. "As OIG states in its report, CMS has extensive policies and procedures in place to ensure that capitation payments are not made to Medicare Advantage organizations after a beneficiary's date of death."

"CMS should implement system enhancements to identify, adjust, and recoup improper capitation payments in the future," Verma said, echoing the recommendations of the auditors. 

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Thank You Ms Meyer and Free Beacon.

21 Medicare Health Plans Warned To Fix Provider Directory Errors

When it positively, absolutely, has to be screwed up overnight, can't even find the people it's paying, let Government take it over and run it.

Kaiser Health News

By Phil Galewitz and Susan Jaffe January 18, 2017

Federal officials this month warned 21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face heavy fines or have to stop enrolling people if the problems are not fixed by Feb. 6.

Among the plans that were cited are Blue Cross Blue Shield of Michigan, Highmark of Pennsylvania, SCAN Health Plan of California as well as some regional plans owned by national carriers such as UnitedHealthcare and Humana.

The action follows the government’s first in-depth review of the accuracy of Medicare Advantage provider directories, which consumers and advocates have complained about for years. More than 17 million Americans, or nearly a third of Medicare beneficiaries, get coverage through private Medicare Advantage plans, which are an alternative to traditional Medicare.

The Centers for Medicare & Medicaid Services in October reported some of the results of the audit, but they had not released names or statistics from the individual plans.

“Because Medicare Advantage members rely on provider directories to locate an in-network provider, these inaccuracies pose a significant access-to-care barrier,” Medicare officials wrote in a report released last week outlining the problems.

Unlike traditional Medicare, the private Medicare plans typically restrict beneficiaries to a network of doctors and hospitals.

Piedmont Community Health Plan, a small Medicare plan with about 5,200 members in southwest Virginia, had the highest rate of inaccuracies among the 54 insurers examined. Officials found errors in the listings of 87 of 108 doctors checked in Piedmont’s directory, according to the report. Most of the errors involved providing the wrong locations for doctors and doctors who should not have been listed.

Piedmont officials did not return calls for comment.

Piedmont and two other plans with the highest error rates — a WellCare plan in Illinois and Emblem Health’s ConnectiCare subsidiary — were required by Medicare to submit specific business plans detailing how they intend to address the issue.

The individual plans receiving warning letters cover more than 1.4 million beneficiaries. Most operate in numerous states, although CMS generally limited its review to a specific state or geographic area.

The federal review focused on reviewing primary care doctors, cardiologists, ophthalmologists and oncologists. It involved individual calls to check on the listings for 108 doctors in each health plan. “We encountered several instances where a call to a provider’s office resulted in determining that the provider had been retired or deceased for a long period of time, sometimes years,” the report said.

The CMS report found almost half of the 5,832 doctors listed had incorrect information, including wrong addresses and wrong phone numbers. Most health plans had inaccurate information for between 30 to 60 percent of their providers’ offices, the report said. The report blamed the insurers for failing to do enough to keep their directories accurate. Members rely on the directories in both deciding whether to join a plan and then in searching for doctors to treat them.

“We saw a general lack of internal audit and testing of directory accuracy among many” Medicare Advantage organizations, the report said.

CMS’ survey found the most error-prone listings involved doctors with multiple offices that did not serve health plan members at each location.

The health plans were sent the warning letters Jan. 6 and given 30 days to fix the mistakes or face possible fines or sanctions, which could include suspending marketing and enrollment. CMS officials said the report was not issued before the annual open enrollment period — which ended Dec. 7 — because of the need to allow the health plans to review the findings before the report was made public.

Medicare Advantage members have until Feb. 14 to disenroll and join traditional Medicare but after that they are locked into their plan for the rest of the year. Seniors may be able to request permission to change plans on a case-by-case basis by calling 800-MEDICARE.

Another 32 companies with less serious mistakes also received letters saying their directories did not comply with a rule that took effect last year requiring plans to contact doctors and other providers every three months and to update their online directories in “real time.”

ConnectiCare spokeswoman Kimberly Kann acknowledged the difficulties. “Keeping these directories up-to-date is a two-way street and we are working with doctors and other medical professionals to continue providing quality service,” she said.

WellCare spokeswoman Crystal Warwell Walker said the Tampa, Fla.-based company took the survey results seriously. “We modified our data gathering techniques and online reporting options to ensure that when more than one address is listed for a provider, that provider is practicing at that location on a routine basis and access to care is not compromised,” she said.

CMS is continuing its investigation of provider directories this year and expects to examine all 300 companies by end of 2018.

Categories: Health Industry, Insurance, Medicare, Syndicate

Tags: Insurers

pgalewitz@kff.org | @philgalewitz

Jaffe.KHN@gmail.com | @SusanJaffe


Thank You Mr Galewitz, Ms Jaffe, and KHN. 

Medicare Failed To Recover Over $125 Million In Overpayments, Records Show

Kaiser Health News

 
By Fred Schulte January 6, 2017

Six years ago, federal health officials were confident they could save taxpayers hundreds of millions of dollars annually by auditing private Medicare Advantage insurance plans that allegedly overcharged the government for medical services.

An initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone, according to confidential government documents released recently in response to a public records request and lawsuit.

But officials never recovered most of that money. Under intense pressure from the health insurance industry, the Centers for Medicare and Medicaid Services quietly backed off their repayment demands and settled the audits in 2012 for just under $3.4 million — shortchanging taxpayers by up to $125 million in possible overcharges just for 2007.

Medicare Advantage is a popular alternative to traditional Medicare. The privately run health plans have enrolled more than 17 million elderly and disabled people — about a third of those eligible for Medicare — at a cost to taxpayers of more than $150 billion a year. And while the plans generally enjoy strong support in Congress, there are critics.
Read More  

 Thank You Mr Schulte and KHN.

NY Doctors Suing United Healthcare For Booting Them From Network Because Of ObamaCare

weaselzippers;

NY Doctors Suing United Healthcare For Booting Them From Network Because Of Obamacare

The continuing ugly ripples of Obamacare.

Because Medicare Advantage will now no longer pay to keep good doctors, not only will patients be losing the doctors that many have had for years (thousands already hit), but because compensation to doctors is cut, the number of competent doctors will be in short supply.

Stealing from Medicare Advantage to pay for Obamacare…the doctors AND insurers should be suing Obama.

Via NY Post:

WASHINGTON — A group of New York doctors is suing insurance giant UnitedHealthcare, charging that it booted doctors from its network to avoid cost hikes imposed by ObamaCare.

The company’s decision to kick more than 2,000 docs from its Medicare Advantage network threatens to harm elderly and disabled patients, according to the filing in Brooklyn federal court.

“By terminating numerous physicians from the . . . network, United seeks to stem financial losses occasioned by reduced federal payments under the Affordable Care Act,” the suit launched by the Medical Society of the State of New York claims.

“This, of course, comes at the expense of physicians,” the suit continues, arguing that the company violated doctors’ contracts by failing to give sufficient notice, among other things.

Keep reading…

Thank You NY Post, Weaselzippers, and Nickarama. 

Issa Subpoenas HHS For Medicare Advantage Documents

Kaiser Health News has a roundup of Rep. Darrell Issa's (R-Ca) overtaxed patience with hhs issuing a subpoena to them for docs related to their 'demonstration' programs with medicare advantage.

Rep. Issa Subpoenas HHS On Medicare Advantage program

OCT 23, 2012

Republicans have suggested that a demonstration project providing more funding to the program is helping to cover up the cuts from the health law. The administration provided 1,300 pages of documents to Issa last week.

Politico: Issa Subpoenas Documents On Medicare Demo
House Oversight and Government Reform Committee Chairman Darrell Issa subpoenaed the Obama administration Monday for documents he believes will expose Medicare malfeasance by Department of Health and Human Services officials. The move, confirmed by an aide to the California Republican, makes good on a threat Issa issued last week, when he demanded reams of data from HHS by 5 p.m. on Thursday. Although the agency dumped 1,300 pages at his doorstep just before the deadline, he contended that the information was garbled and unresponsive to his request (Cheney, 10/22).

CQ HealthBeat: Issa Subpoenas Documents On Medicare Advantage Program
The chairman of the House Oversight and Government Reform Committee issued a subpoena Monday for documents related to a Medicare Advantage demonstration project. ... Republicans have attacked the three-year demonstration, which would increase payments to private health care plans in Medicare, as a way to cover up cuts to the Medicare Advantage program that were included in the 2010 health care law. ... But on Monday, Elijah E. Cummings, the top Democrat on the Oversight panel, accused Issa of playing politics.
"Since HHS committed to producing the documents and is already in the process of producing them, this subpoena seems to be just for show ahead of the presidential election," the Maryland Democrat said in an emailed statement (Attias, 10/22).

Fox News: Issa Issues Subpoena Over HHS Documents
Issa claims the bonus program is being used to mask the first round of Medicare Advantage cuts in connection with the health care overhaul -- in order to win favor with seniors. "It's an unbelievable abuse of power," he said Thursday. Issa said the program basically funds "what ObamaCare took away." The program in question is called a "demonstration" project. But Issa complains the project is far more sweeping than a run-of-the-mill test program, and conveniently lasts until 2014. "This is larger than every test they've ever done at HHS combined," Issa said (10/22).

Meanwhile, there is also concern among Republicans about Medicare ID theft.

The Hill: GOP Lawmakers Slam HHS Over Identity-Theft Risk In Medicare
Leaders on a top House committee are pushing the federal Health Department to change the way it identifies people on Medicare. To reduce the risk of identity theft, the Department of Health and Human Services (HHS) must remove Social Security numbers from the Medicare card, the GOP lawmakers charged Monday. Reps. Wally Herger (R-Calif.) and Sam Johnson (R-Texas) of the House Ways and Means Committee have argued several times that health officials should overhaul the Medicare card. On Monday, they linked their cause to a new report finding flaws in the way HHS responds to the problem of Medicare identity theft (Viebeck, 10/22).

CQ HealthBeat: HHS Inspector General Raps CMS On Medicare ID Theft Protection
Federal Medicare officials reported 14 breaches of medical information in two years affecting nearly 14,000 beneficiaries, but they failed to notify those affected in a timely way and often did not give them much information about the violation, the Office of Inspector General for the Department of Health and Human Services said in a new report. In response to worries about medical identity theft, the government has set up a database with the Medicare ID numbers of 284,000 beneficiaries and 5,000 providers that have been involved in medical identity theft in the past or are regarded as vulnerable. But Medicare contractors have problems using the database, and few remedies are available for those whose numbers have been compromised, the OIG report said (Norman, 10/22).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Thanks to Kaiser, all reporters involved, and especially to Representative Issa.