Much like urban legends, the recurring tales of Medicare Advantage (MA) plans being accused of manipulating diagnoses and denying care that otherwise would have been covered under traditional Medicare are gaining traction.
They are now even being referred to as Medicare “Dis-Advantage” plans because of all the manipulation, much related to the fact that a MA patient is more expensive to the Medicare program than a traditional Medicare patient. The government pays MA insurers a set amount for each person who enrolls, with higher rates for sicker patients.
But the Department of Justice (DOJ) recently uncovered irregularities in reporting accurate patient diagnoses, even accusing some insurers of developing elaborate systems to make their patients appear as sick as possible, often without providing additional treatment.
During the next live edition of Talk Ten Tuesdays, nationally recognized healthcare consultant Terry Fletcher will report on the details.
Other segments during the live broadcast will include the following: