Medicare Insurers Upcoding — overbill Medicare $650 million

Medicare Insurance plans are fraudulently over-billing Medicare, costing the US taxpayers hundreds of millions of dollars, according to Medicare auditors. Nearly 16 million elderly Americans have Medicare Advantage Plus, one of the Medicare insurance plans involved in the over-payments.

Five other plans and Medicare Advantage Plus were found to have been overpayed from approximately $650 million.

Medicare pays higher rates for people who are sicker as their care is more expensive. However, the audit showed that these insurers targeted the patients because they were more ill and over billed for services.

One major Texas health plan was paid to care for a man it said had brain cancer. However, his medical file showed he was not treated for brain cancer, rather he was treated for an enlarged prostate.

The traditional Medicare program was launched in 1966 and in this model, the government pays doctors and other medical professionals according to the fee for service concept. Congress decided that Medicare would pay healthcare plans a monthly rate for each person enrolled. Eventually, Medicare began paying more for sicker patients.

Medicare Advantage health plans began reporting patients were sicker than the Medicare population as a whole.

Jeff Newman represents whislteblowers.