Medicare Advantage plans are plans operated by private insurance companies to provide healthcare for seniors. The insurance companies are contracted with the Federal Government to cover almost 16 million Americans eligible for Medicare. Unfortunately, auditors have determined that six of these insurance companies were overpaid hundreds of millions of dollars.
Auditors reviewing claims from Medicare Advantage programs found that the six health plans that were audited were not able to justify the money they were paid for more than 40 percent of their patients. As a result, in 2007 alone, more than $650 million in improper payments may have been made. As NBC News reports, this money is likely gone forever.
Identifying fraud in government programs can be difficult and actually recovering the money presents myriad challenges. One of the best options the government has for stopping overpayments and improper payouts is when whistleblowers come forward to report wrongdoing. A whistleblower attorney in Texas can help individuals who have evidence of unlawful behavior to come forward and help stop the waste of taxpayer funds. Whistleblowers may also be entitled to a payout of a portion of the money the government is able to obtain when fraud is reported.
Medicare Advantage Plans Wasting Millions
The Medicare Advantage plans inflated their expenditures in many ways. One major Texas health plan, for example, reportedly claimed that one of its patients had brain cancer and thus additional payouts were necessary to treat him. The reality was that his medical records revealed he had been treated for an enlarged prostate. This is a common medical problem that would not entitle the Advantage plan to any additional payment.
In two other examples of unsupported diagnosis coding, an Arizona patient was treated for knee pain but her condition was reported as congestive heart failure and a Pennsylvania patient was classified as having serious heart disease when she really had blurry vision.
It took several years for the inspector general of the Department of Health and Human Services to publish findings from the audit of the six Medicare Advantage plans, and government officials have been able to recover only a fraction of the money from the disputed payouts. Further, the inspector general has done no more audits and in 2013, it was decided not to do future reviews in order to save money because of budget cuts.
The bottom line is, the government does not have the financial resources to conduct comprehensive audits, put together strong cases of intentional wrongdoing, or go after the money unless it has clear evidence of fraud. No company has admitted to wrongdoing, and the audits that were conducted do not assign blame. As a result, the money is not likely to be returned.
If whistleblowers become aware of wrongdoing, however, it may be possible to stop fraudulent billing before it costs billions and it may be easier for the government to avoid paying funds for healthcare services that were never provided so that money can be used to provide care to those who truly need help.
Contact a Medicaid fraud attorney if you believe you have evidence of fraud. Call Brewer & Prichard P.C. today at 800-445-8710 or visit https://www.bplaw.com to schedule a consultation.