Medicare Advantage plans, the popular private-insurance alternative to the traditional Medicare program, have been improperly denying many medical claims to patients and physicians alike, federal investigators say in a new report.
The private plans, which now cover more than 20 million people — more than one-third of all Medicare beneficiaries — have an incentive to deny claims “in an attempt to increase their profits,” the report says.
The findings, by the inspector general at the Department of Health and Human Services, come as policies in Washington are creating new incentives for older Americans to enroll in Medicare Advantage plans. Some experts predict that the share of Medicare patients in the private plans could grow to one-half in a few years.
“Because Medicare Advantage covers so many beneficiaries, even low rates of inappropriately denied services or payment can create significant problems for many Medicare beneficiaries and their providers,” said the report by the inspector general, Daniel R. Levinson.
– The New York Times