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Fed Demands “$4.7 BILLION” Repayment From Medicare Companies
- The Medicare agency’s plan to seek $4.7 billion over 10 years in clawback payments from private health insurers who manage its programs, as reported in the article, could have a significant impact on Medicare and seniors who are recipients of the program.
- Medicare Advantage plans are a growing source of profit for private insurers, but these plans have been accused of receiving excessive payments based on exaggerated claims of patient illness. The new rule, which governs audits of Medicare Advantage insurers, is aimed at recovering these payments, and the final version is tougher than the industry had hoped for.
- The final rule requires Medicare Advantage plans to be held accountable for errors in more recent data, and the CMS plans to recover $479 million from plans for the 2018 audit year. The total amount expected to be recovered is less than 0.2% of total payments to Medicare Advantage plans, but the impact could still be significant for seniors who rely on these programs.
- Moreover, if the rule survives court challenges, it could increase the amount Medicare insurers will eventually have to repay the government, which could result in higher costs for seniors who use the Medicare Advantage program. Industry groups have criticized the policy, with the leading insurers’ lobby calling it “unlawful,” and some investors fear that this could lead to court challenges, which could delay the implementation of the rule and put Medicare and seniors in a state of uncertainty.
- In conclusion, the new rule by the Medicare agency to seek clawback payments from private health insurers could have a significant impact on Medicare and seniors, leading to higher costs and potential court challenges that could put the program and its recipients in a state of uncertainty.
