HHS identifies overpayments to Medicare advantage plans but doesn't recover funds

Medicare auditors found the government overpaid the plans hundreds of millions of dollars but in 2013 opted to scrap such reviews, the Center for Public Integrity writes. Meanwhile, Modern Healthcare looks at Medicare's difficult job in dealing with safety failures.

Center for Public Integrity: Health Insurers Have Their Way With Regulators
Four years ago, Medicare auditors came to an alarming conclusion: the federal government shouldn't have paid a half-dozen insurance plans hundreds of millions of dollars to treat seniors in especially poor health. ... It took years for the Department of Health and Human Services (HHS) inspector general to publish those findings, and government officials have yet to pry back more than a tiny fraction of the disputed money, the Center for Public Integrity has learned. And despite the bundle of taxpayer dollars on the line, the HHS inspector general didn't do any more audits, and decided in 2013 to scrap similar future reviews as part of a budget cut (Schulte, 6/9).

Modern Healthcare: Cleveland Clinic Cases Highlight Safety Oversight Flaws
Nearly four years ago, government inspectors investigating a complaint by retired Air Force Col. David Antoon threatened to cut off Cleveland Clinic from receiving Medicare payments after being stonewalled by hospital officials. The Vietnam combat veteran had accused the hospital of failing to fully investigate his charge that someone other than his authorized surgeon had performed prostate cancer surgery and left him gravely injured. Hospital officials refused to show the inspectors all of the notes in Antoon's complaint file, and the doctor who claimed to have done the procedure declined to talk to surveyors .... Antoon, a commercial 747 pilot in civilian life until the operation left him incontinent, is baffled that medicine has no organization like the National Transportation Safety Board to address safety failures (Carlson, 6/7).

http://www.kaiserhealthnews.orgThis article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


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