Despite its successes in diversifying government health care coverage for seniors over the past 15 years, the Medicare Advantage managed-care program increasingly has come under attack for excessive and unscrupulous billing practices that are costing taxpayers billions of dollars.
The Government Accountability Office (GAO), the premier non-partisan watchdog, has repeatedly complained of inadequate auditing by the Centers for Medicare & Medicaid Services (CMS) to ferret out wrongdoing or inaccurate billings by scores of for-profit health care insurers that take part in the program.
In 2014, Medicare paid about $160 billion to Medicare Advantage organizations to provide health care services for about 16 million beneficiaries, according to GAO. CMS, which administers the program, estimates that about 9.5 percent of its payments to Medicare Advantage organizations were improper, owing largely to unsupported diagnoses submitted by the private insurers.
– The Fiscal Times