KFF Health News Sues To Force Disclosure of Medicare Advantage Audit Records

[erronis]

Source: KFF Health News Network

KFF Health News has sued the U.S. Department of Health and Human Services Office of Inspector General to compel it to release a range of Medicare Advantage health plan audits and other financial records.

The suit, filed Nov. 12 in U.S. District Court in San Francisco under the Freedom of Information Act, or FOIA, seeks documents from the HHS inspector general’s office, which acts as a watchdog over federal health insurance programs run by the Centers for Medicare & Medicaid Services.

The suit asks for correspondence and other records of contact between HHS officials or their representatives and Medicare Advantage organizations concerning overpayment audit findings and potential financial penalties.

It also seeks records reflecting communication between HHS and CMS officials regarding the government’s policies for recovering overpayments discovered during Medicare Advantage audits, including a controversial decision in January 2023 to limit dollar recoveries for audits dating back a decade or more. Additionally, the suit seeks copies of government contracts awarded to outside firms that have conducted Medicare Advantage audits, including budgets and performance evaluations, dating to 2020. In these audits, reviewers take a sample of 200 patients from a health plan and determine whether medical records support the diagnoses the government paid health plans to treat.

Read more: https://kffhealthnews.org/news/article/lawsuit-hhs-disclosure-medicare-advantage-audit-records-inspector-general/

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Thank you, Joe Biden and this administration!

When the oligarchs take over anyone on Medicare will automatically be moved to an "Advantage" plan - one that makes sure you die as quickly as possible.

[Silent Type]

1. The sad thing is that since Clinton's admin, big changes to healthcare have relied on private insurance companies.

Part C which evolved into Medicare Advantage was originally signed by Clinton, ACA relies on privated insurance companies, so do Part D drug plans, most states rely on private health insurers in their Medicaid programs, medigap has always been private insurane.

And of course, even original Medcare relies on subidiaries of private insurance companies to pay claims, interpret coverage requirements, credential providers, audit providers, answer beneficiary questions, etc.

Guess we can fight it, but we won't get anything major done.

[erronis]

2. The corporate insurance racket is wound into so much of our lives

From birth through living and then death. Extracting their tolls at every step.

Whole industries of non-actuarial types built upon processing the immense amount of data with no benefit to the nation and the people.

Used to work for a state regulatory organization that was severely out-gunned by the insurance companies, the major healthcare providers, and even the state government (lobbyist influencers.)

[Silent Type]

3. I guess the positive is that trump's admin won't take the gravy train away by repealing ACA, etc. Not to mention

ACA covers 20 million and Medicare 67 million (half in Medicare Advantage). And a bunch of those are GOPers.

[Skittles]

4. the goal is to force everyone to take part in the "Advantage" scam

THAT is when Medicare will cease to exist

FUCK THEM