{"id":568208,"date":"2023-03-31T13:00:00","date_gmt":"2023-03-31T10:00:00","guid":{"rendered":"https:\/\/en.buradabiliyorum.com\/republicans-divided-over-tackling-medicare-advantage-overpayments\/"},"modified":"2023-03-31T13:00:00","modified_gmt":"2023-03-31T10:00:00","slug":"republicans-divided-over-tackling-medicare-advantage-overpayments","status":"publish","type":"post","link":"https:\/\/buradabiliyorum.com\/en\/republicans-divided-over-tackling-medicare-advantage-overpayments\/","title":{"rendered":"#Republicans divided over tackling Medicare Advantage overpayments"},"content":{"rendered":"<p><img decoding=\"async\" src=\"https:\/\/thehill.com\/wp-content\/uploads\/sites\/2\/2023\/02\/cassidybill_020923gn2_w.jpg?w=900\" \/><\/p>\n<div>\n<p>Hard-pressed to come up with significant savings to reduce the deficit, some Senate Republicans are taking a closer look at reforms to Medicare Advantage in light of reports that insurance companies are collecting billions of dollars in extra profits by over-diagnosing older patients. \u00a0<\/p>\n<p>But the idea of cracking down on Medicare Advantage overpayments to insurance companies divides Republicans, who have traditionally championed the program.\u00a0<\/p>\n<aside class=\"ad-unit ad-unit--mr1_ab\"><\/aside>\n<p>Proponents of Medicare Advantage reform anticipated it will face strong opposition from the insurance industry, one of the most powerful special interest groups in Washington. \u00a0<\/p>\n<p>Sen. Bill Cassidy (La.), the top-ranking Republican on the Senate Health, Education, Labor and Pensions Committee, is leading the push to reduce Medicare overpayments. \u00a0<\/p>\n<p>\u201cMedicare is going insolvent. If we don\u2019t do anything, it\u2019s going to go insolvent. We have a whole package of things, all of them bipartisan, and we\u2019re doing it essentially to have something out there so that if somebody decides to do something, there will be things that are examined, considered and bipartisan\u201d to vote on, he said. \u00a0<\/p>\n<p>\u201cI come up with lots of stuff. We thought it through policy and think it\u2019s policy that can make it all the way through,\u201d he said.<\/p>\n<p>Cassidy\u2019s office says his bill could extend the solvency of Medicare by saving as much as $80 billion\u00a0in\u00a0federal funds over the next decade without cutting benefits.<\/p>\n<p>He emphasizes that it would not cut Medicare Advantage benefits, but critics of the legislation are sure to challenge that claim. \u00a0<\/p>\n<aside class=\"ad-unit ad-unit--mr2_ab\"><\/aside>\n<p>\u201cWe\u2019re not undermining Medicare Advantage,\u201d he said. \u00a0<\/p>\n<p>\u201cIn fact, I would say this is a better alternative than what CMS is doing by rule,\u201d he added, referring to a new rule-making action by the Biden administration to recover overpayments in Medicare Advantage through the Centers for Medicare &amp; Medicaid Services.<\/p>\n<p>The Medicare Payment Advisory Panel estimates that Medicare Advantage plans collected $124 billion in overpayments from 2008 to 2023. They collected an estimated $44 billion overpayments in 2022 and 2023 alone, according to MedPAC.\u00a0<\/p>\n<aside class=\"ad-unit ad-unit--mr3_ab\"><\/aside>\n<p>Unlike traditional fee-for-service Medicare, Medicare Advantage plans are offered by private companies. Both are funded by taxpayers through <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/general\/\" data-internallinksmanager029f6b8e52c=\"3\" title=\"General\" target=\"_blank\" rel=\"noopener\">general<\/a> revenues, payroll taxes and beneficiaries\u2019 premiums.\u00a0<\/p>\n<p>Cassidy is also leading a bipartisan working group to reform <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/social-mediaa\/\" data-internallinksmanager029f6b8e52c=\"1\" title=\"Social Media\" target=\"_blank\" rel=\"noopener\">Social<\/a> Security to extend its solvency. Members\u00a0include Sens. Angus King (I-Maine) and Mitt Romney (R-Utah). \u00a0<\/p>\n<p>\u201cTo have a significant impact on fiscal policy, you\u2019d have to look at entitlements,\u201d said Romney, who called Medicare Advantage \u201can area we\u2019re going to be looking at very shortly \u2014 the committee will be looking at Medicare Advantage, the cost of Medicare Advantage \u2026. It\u2019s become more expensive than the old fee-for-service Medicare.\u201d\u00a0\u00a0<\/p>\n<aside class=\"ad-unit ad-unit--mr4_ab\"><\/aside>\n<p>In a follow-up interview Thursday, Romney said senators are also looking at reforms to Pharmacy Benefit Managers, the companies that serve as middle-men between drug manufacturers, insurance companies and pharmacies. \u00a0<\/p>\n<p>Romney said, \u201cin the past, Medicare Advantage has been a lower-cost way of providing Medicare than fee-for-service Medicare.\u201d\u00a0<\/p>\n<p>\u201cIf that\u2019s changing, I\u2019d like to understand why and make sure we don\u2019t create impediments to the lower-cost Medicare Advantage,\u201d he said. \u00a0<\/p>\n<aside class=\"ad-unit ad-unit--mr5_ab\"><\/aside>\n<p>Sen. Mike Braun (R-Ind.) said Medicare Advantage overpayment \u201cdefinitely\u201d is a \u201creform issue.\u201d\u00a0<\/p>\n<p>\u201cI\u2019ve been the loudest voice on reforming health care and that\u2019s a commonsense idea,\u201d he said. \u201cWhatever it takes to bring down health care costs.<\/p>\n<p>\u201cI\u2019m one of the most free-market people here, but the health care industry is not a free market. It\u2019s like an unregulated utility,\u201d he said. \u201cThere\u2019s so much opaqueness.\u201d \u00a0<\/p>\n<aside class=\"ad-unit ad-unit--mr6_ab\"><\/aside>\n<p>But some Republicans are already trying to paint efforts to reduce overpayments as cuts to Medicare Advantage. \u00a0<\/p>\n<p>\u201cThe problem with Medicare Advantage is President Biden is cutting $540 per member per year. That\u2019s the problem. Medicare Advantage has been very successful,\u201d said Sen. Roger Marshall (R-Kan.), an OB\/GYN who practiced medicine for more than 25 years. \u00a0<\/p>\n<p>National Republican Senatorial Committee Chairman Steve Daines (R-Mont.) accused Biden of \u201cproposing Medicare Advantage cuts\u201d when the president accused some Republicans of wanting to sunset Medicare at his Feb. 7 State of the Union address. \u00a0<\/p>\n<aside class=\"ad-unit ad-unit--mr7_ab\"><\/aside>\n<p>Medicare Advantage is getting more popular among Democrats as well as the number of\u00a0blue state\u00a0enrollees in the program soars. The number of Americans enrolled in Medicare Advantage has nearly doubled over the last 12 years, according to the Kaiser Family Foundation. <\/p>\n<p>Cassidy\u2019s proposal, which he introduced with progressive Sen. Jeff Merkley (D-Ore.) on Monday, could draw broader interest from Republicans.<\/p>\n<p>Sen. John Cornyn (R-Texas), an adviser to the Senate GOP leadership, called Medicare Advantage a \u201csuccess.\u201d<\/p>\n<p>\u201cThat doesn\u2019t mean that it should be immune from oversight, so I\u2019ll be interested to see what they have to say,\u201d he said. \u00a0<\/p>\n<p>Cassidy and Merkley say that Medicare Advantage plans have a financial incentive to make beneficiaries <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/download-scripts-themes-apps\/\" data-internallinksmanager029f6b8e52c=\"9\" title=\"Download Scripts &amp; Themes &amp; Apps\" target=\"_blank\" rel=\"noopener\">app<\/a>ear sicker than they are because they are paid a standard rate based on the health of individual patients. Their bill, the No Unreasonable Payment, Coding or Diagnoses for Elderly (No Upcode Act) would require risk models based on more extensive diagnostic data over a period of two years. \u00a0<\/p>\n<p>It would also limit the ability of insurance companies to use old or unrelated medical conditions to inflate the cost of care and ensure that Medicare is only charged for treatment related to relevant medical conditions, according to a summary provided by the senators\u2019 offices.<\/p>\n<p>The goal is to narrow the disparity in how patients are assessed by traditional Medicare and Medicare Advantage. \u00a0<\/p>\n<p>Studies and audits conducted by CMS and the Department of Health and Human Services\u2019 inspector general found that insurance companies collected billion of dollars in overpayments because of diagnoses that were not later supported by enrollees\u2019 medical records.<\/p>\n<p>The Kaiser Family Foundation reported in August that more than 28 million people \u2014 or about 48 percent of the eligible Medicare population \u2014 were enrolled in Medicare Advantage plans in 2022. They accounted for $427 billion or 55 percent of total federal Medicare spending.<\/p>\n<\/div>\n<p>Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.<\/p>\n<blockquote><p><strong><span style=\"color: #ff6600;\">If you liked the article, do not forget to share it with your friends. Follow us on\u00a0<span style=\"color: #ff0000;\"><a style=\"color: #ff0000;\" href=\"https:\/\/news.google.com\/publications\/CAAqBwgKMLG0nwswvr63Aw\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Google News<\/a><\/span>\u00a0too, click on the star and choose us from your favorites.<\/span><\/strong><\/p><\/blockquote>\n<blockquote>\n<p style=\"text-align: center;\">For forums sites go to <span style=\"color: #ff9900;\"><a style=\"color: #ff9900;\" href=\"https:\/\/forum.buradabiliyorum.com\/\" target=\"_blank\" rel=\"noopener\">Forum.BuradaBiliyorum.Com<\/a><\/span><\/strong><\/p>\n<\/blockquote>\n<blockquote>\n<p style=\"text-align: center;\"><strong>If you want to read more <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/news\/\" data-internallinksmanager029f6b8e52c=\"2\" title=\"News\" target=\"_blank\" rel=\"noopener\">News<\/a> articles, you can visit our <span style=\"color: #ff9900;\"><a style=\"color: #ff9900;\" href=\"https:\/\/en.buradabiliyorum.com\/news\/\" target=\"_blank\" rel=\"noopener\">News category.<\/a><\/span><\/strong><\/p>\n<\/blockquote>\n<p><span style=\"color: black;\"><a style=\"color: #ff9900;\" href=\"https:\/\/thehill.com\/homenews\/senate\/3927032-republicans-divided-over-tackling-medicare-advantage-overpayments\/\" target=\"_blank\" rel=\"noopener\">Source<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hard-pressed to come up with significant savings to reduce the deficit, some Senate Republicans are taking a closer look at reforms to Medicare Advantage in light of reports that insurance companies are collecting billions of dollars in extra profits by over-diagnosing older patients. \u00a0 But the idea of cracking down on Medicare Advantage overpayments to&#8230;<\/p>\n","protected":false},"author":1,"featured_media":568209,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"fifu_image_url":"https:\/\/thehill.com\/wp-content\/uploads\/sites\/2\/2023\/02\/cassidybill_020923gn2_w.jpg?w=1280","fifu_image_alt":"","footnotes":""},"categories":[70897],"tags":[134417,134353,86421,124783,142001,70464,134351,70289,137647,134345],"class_list":["post-568208","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-blog-briefing-room","tag-court-battles","tag-criminal-justice","tag-international","tag-medicare-advantage","tag-mitt-romney","tag-morning-report","tag-senate","tag-senate-republicans","tag-state-watch"],"_links":{"self":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts\/568208","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/comments?post=568208"}],"version-history":[{"count":0,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts\/568208\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/media\/568209"}],"wp:attachment":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/media?parent=568208"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/categories?post=568208"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/tags?post=568208"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}