Special Alert | Focus On Medicare Advantage

 

May 5, 2022 Call to Action – Policy Makers Must Increase Medicare Advantage Oversight and Rein in Overpayments _______________ For many years, the Center for Medicare Advocacy has advocated for legislative and administrative efforts to address the growing inequities between Medicare Advantage (MA) and traditional Medicare, that favor MA, and encourage the growing privatization of the Medicare program. These inequities include overpayments to MA plans that unnecessarily drive-up Medicare spending, and lax oversight of MA plans that fails to impose adequate consumer protections. This week’s Special CMA Alert focusing on the Medicare Advantage (MA) program includes five separate, but related articles outlining several critical issues. First, Marilyn Moon, Ph.D., Center for Medicare Advocacy Visiting Scholar and former Medicare Trustee, writes about the harm in letting MA take over the Medicare program in her opinion piece, Medicare Advantage is Not the Solution to Medicare Equity or Solvency Problems.   Second, the Center for Medicare Advocacy’s CMA Alert, entitled Office of Inspector General (OIG) Issues Another Report Highlighting Inappropriate Medicare Advantage Denials, offers an assessment of the latest evidence that MA plans deny too much care.    Third, we discuss the Insurance Industry v. Provider Response to the recent OIG Report re: MA Denials, highlighting that despite how much the insurance industry tries to downplay the report’s findings, many providers of care to MA enrollees are frustrated with MA plans’ prior authorization and coverage denials.   Fourth, while the OIG report’s findings about MA denials are disturbing enough on their own, the Center describes how the OIG Report Estimates of Inappropriate MA Plan Denials May be Understated. Based on our own experience with OIG’s audits of home health claims, coupled with the recent growth in MA plans’ use of artificial intelligence (AI)-driven software that seems to result in terminations of skilled nursing facility and other care sooner and more frequently, we fear that problems with MA may be even worse than OIG found.   Fifth, and finally, we continue our efforts to highlight that (Most) Policy makers Fail to Act on Medicare Advantage Oversight and Overpayment.  Some lawmakers, however, are pushing back against the increasing privation of Medicare, the inertia to do anything about it, and the insurance industry’s influence.