Let me briefly connect some dots on the Wall Street Journal’s (WSJ) recent coverage of private Medicare Plans known as Medicare Advantage (MA) plans. The investigation of this 11/14 article concludes that the sickest patients eligible for Medicare are “fleeing” MA plans because of inadequate insurance coverage. At the same time, these private plans collect 20 percent more from the taxpayers for their patients because the MA plans claim they care for sicker patients. The MA plans use coding to assert that their patients are sicker. This 10/24 WSJ article offers compelling evidence that the MA plans manipulate the coding system (rather than care for sicker patients) to receive higher taxpayer payments.
To make matters worse, MA plans also pay less to doctors and hospitals for care than regular Medicare. They achieve this outcome by denying claims and paying providers lower payments. This lower payment level has caused providers to cancel contracts with MA plans because they are losing too much money on these contracts, as noted in this USA Today article.
In summary, taxpayers and Medicare are overpaying MA plans by billions of dollars, and patients and providers are being harmed by these plans. The coding system, which is ridiculously complicated and easily manipulated, makes all this abuse possible. These abuses will continue as long as healthcare utilizes coding to determine insurance and provider payments. Alternatives to coding exist for paying providers and insurers. Visit www.thejourneys-end.org to learn more about these options. Hopefully, the new Administration will be open to these innovative solutions.
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