"But some health policy experts say the plan could help reduce billions of dollars in overcharges that have been common in the program for more than a decade. On Jan. 26, Centers for Medicare & Medicaid Services officials announced they planned to raise rates paid to health plans by less than a tenth of a percent for 2027,"
"Less noticed in the brouhaha over rates: CMS also proposed restricting plans from conducting what are called "chart reviews" of their customers. These reviews can result in new medical diagnoses, sometimes including conditions patients haven't even asked their doctors to treat, that increase government payments to Medicare Advantage plans. The practice has been criticized for more than a decade by government auditors who say it has triggered billions of dollars in overpayments to the health plans."
"Earlier this month, the Justice Department announced a record $556 million settlement with the nonprofit health system Kaiser Permanente over allegations the company added about half a million diagnoses to its Advantage patients' charts from 2009 to 2018, generating about $1 billion in improper payments. KP did not admit any wrongdoing as part of the settlement. "I do think the administration is serious about cracking down on overpayments," said Spencer Perlman, a health care policy analyst in Bethesda, Mary"
CMS proposed nearly flat Medicare Advantage reimbursement rates for 2027, raising payments by less than one-tenth of a percent. Major insurers experienced stock drops and warned of possible service cuts for beneficiaries. Some health policy experts say the plan could reduce billions of dollars in longstanding overcharges in the program. CMS also proposed restricting insurers' use of "chart reviews" that add diagnoses and boost payments. Government auditors have criticized chart-review-driven diagnosis additions for triggering billions in overpayments. The Justice Department reached a $556 million settlement with Kaiser Permanente over alleged improper additions that generated about $1 billion in improper payments.
Read at www.npr.org
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