Inspector General Finds Wide Variation in How MA Plans Detect Fraud
The HHS Office of Inspector General has found wide differences in how Medicare Advantage plans "defined and detected potential fraud," which could affect their ability to mitigate such problems, Modern Healthcare reports.
HHS OIG found that in 2009, three of 170 MA plans identified 95% of the 1.4 million reported incidents of suspected fraud and abuse.
CMS requires MA plans to launch "inquiries and corrective actions" in some cases, but OIG investigators found that not all plans took such actions when they detected potential fraudulent activity.
CMS agreed with several recommendations in the report and plans to update instructions on how to "detect, correct, identify and prevent fraud, waste and abuse." However, CMS will not follow other recommendations, including conducting a program-wide review of all MA plans to determine the cause of the disparities (Daly, Modern Healthcare, 2/24).
Obama Administration Discuss Anti-Fraud Steps
The Obama administration is taking steps to gradually reduce improper payments to MA plans, with expected savings of $370 million this year and more over time, the AP/U-T San Diego reports.
Under a new policy, MA plans will face tighter audits but will receive a higher payment rate for sicker beneficiaries. Previous audits have found many claims did not have the proper medical documentation, leading to an error rate of about 11% last year (AP/U-T San Diego, 2/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.