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Home » Valentine's Day » Billions of dollars are being overpaid to Medicare Advantage plans and Medicare recipients are incorrectly labeled “high-risk”

Billions of dollars are being overpaid to Medicare Advantage plans and Medicare recipients are incorrectly labeled “high-risk”

The federal government has been looking into the Medicare Advantage plans and alleges that many had had overpayments.

42% of Medicare recipients are on the Medicare Advantage plan.

Humana has allegedly claimed patients are sicker than they really are, overcharging the program by $200 million.


Anthem has done the same, receiving an extra $3.4 million for saying patients were high-risk, when they were not.

Aetna has disclosed that HHS OIG was targeting their MA plans in a filing with the Securities and Exchange Commission.

Many individuals on average that are part of the Medicare Advantage plan cost the government around $321 more dollars than anyone in a regular Medicare program.

After analyzing the data, HHS OIG discovered that around 12% of insurers had disproportionally higher payments.

in 2017 the 12%, or 20 insurers, generated half of the $9.2 billion for high-risk payments- yet were responsible for less than one third of Medicare Advantage members.

One company that is not being named and had 40% of the total payments, but had only enrolled 22% of Medicare Advantage workers.

After the unnamed company for highest total payments was UnitedHealthcare, followed by Humana, and then Blue Cross Blue Shield.



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