{"id":25765,"date":"2023-04-03T11:47:47","date_gmt":"2023-04-03T18:47:47","guid":{"rendered":"https:\/\/occupysf.net\/?p=25765"},"modified":"2023-04-03T11:47:49","modified_gmt":"2023-04-03T18:47:49","slug":"bending-the-knee-to-insurance-lobby-biden-admin-delays-medicare-advantage-reforms","status":"publish","type":"post","link":"https:\/\/occupysf.net\/index.php\/2023\/04\/03\/bending-the-knee-to-insurance-lobby-biden-admin-delays-medicare-advantage-reforms\/","title":{"rendered":"‘Bending the Knee’ to Insurance Lobby, Biden Admin Delays Medicare Advantage Reforms"},"content":{"rendered":"\n
\"U.S.<\/figure>\n\n\n\n

U.S. Health and Human Services Secretary Xavier Becerra testifies before the Senate Finance Committee on March 22, 2023 in Washington, D.C. <\/p>\n\n\n\n

(Photo: Kevin Dietsch\/Getty Images)<\/p>\n\n\n\n

“Medicare Advantage providers whined for months that they simply couldn’t survive without being able to rip off the government, so the government said ‘you can rip us off for just a little longer,'” said one critic.<\/h2>\n\n\n\n

JAKE JOHNSON<\/a><\/p>\n\n\n\n

Apr 01, 2023 (CommonDreams.org)<\/a><\/a><\/a><\/a><\/a><\/p>\n\n\n\n

The Biden administration announced Friday that it will allow Medicare Advantage<\/a> plans to continue overbilling<\/a> the federal government in the short term after the insurance industry lobbied aggressively<\/a> against proposed rule changes aimed at cracking down on fraud in the privately run program.<\/p>\n\n\n\n

The Centers for Medicare and Medicaid Services (CMS) said<\/a> it is still moving ahead with the changes despite industry pressure to drop or completely overhaul them.<\/p>\n\n\n\n

But instead of implementing the reforms all at once, CMS outlined a plan<\/a> to phase in the changes over a three-year period, a concession to large insurers that dominate<\/a> the Medicare Advantage market\u2014which is funded by the federal government.<\/p>\n\n\n\n

“How Washington really works: Medicare Advantage providers whined for months that they simply couldn’t survive without being able to rip off the government, so the government said ‘you can rip us off for just a little longer,'” The American Prospect<\/em>‘s David Dayen tweeted<\/a> in response to the CMS announcement.<\/p>\n\n\n\n

The changes<\/a> involve tweaks to the Medicare Advantage risk-adjustment model, which determines<\/a> how much the federal government pays insurers to cover patient care.<\/p>\n\n\n\n

Medicare Advantage plans are notorious for piling on diagnoses<\/a> to make patients appear sicker<\/a> than they are to reap larger payments from the federal government. CMS estimates<\/a> that overpayments to Medicare Advantage totaled $11.4 billion in fiscal year 2022, a sizeable drain on the Medicare trust fund.<\/p>\n\n\n\n

“Nearly every large insurer in the program has settled or is facing a federal fraud lawsuit for such conduct,” The New York Times<\/em>noted<\/a> Friday. “Evidence of the overpayments has been documented by academic studies, government watchdog reports, and plan audits.”<\/p>\n\n\n\n

Mark Miller, the executive vice president of healthcare for the philanthropy Arnold Ventures, expressed concern<\/a> that the Biden administration’s decision to phase the Medicare Advantage changes in over three years will “continue to reward those insurers with the most abusive practices over the next two years.”<\/p>\n\n\n\n

“We are disappointed to hear that reasonable changes targeting abuse and waste in Medicare Advantage will be phased in over three years rather than fully implemented immediately,” said Miller. “The coding abuses by insurers in Medicare Advantage have led the independent Medicare commission (MedPAC), which was created to advise Congress, to call for a ‘major overhaul<\/a>‘ of Medicare Advantage policies.”<\/p>\n\n\n\n

Disappointing to see the Biden administration bending the knee to the insurance industry while they fleece seniors and taxpayers billions https:\/\/t.co\/lEjPJGp51f<\/a><\/p>— James A. Williams (@JamesWilliams9) March 31, 2023<\/a><\/blockquote>