The Biden Administration Going after Insurance Fraud — From Insurers

The Biden administration thinks some health insurers are bilking the U.S. taxpayer and it’s going to go after them. The Department of Health and Human Services (HUD) has been looking into this kind of fraud for a couple of years and now has a plan to address the problem.

Of concern is the private version of Medicare that we call the Medicare Advantage programs. Federal investigators say they have found some companies claiming their members are sicker than they really are and, as a result, they’re collecting inflated payments.

Estimates from HUD are that as much as $4.7 billion is being improperly billed. The administration says the money could come back to the Treasury from new, and tougher, penalties for submitting improper charges.

HUD Secretary Xavier Becerra said his department will start collecting money from insurers when an audit shows they’re charging HUD for diagnoses that are not contained in the patient’s medical records.

“Today, we are taking some long overdue steps to move us in the direction of accountability,” he said when the plan was announced a week ago. The $4.7 billion is how much he thinks will be collected in the next decade.

Matt Eyles is the president of America’s Health Insurance Plans (AHIP). He’s worried about the accuracy of the administration’s audits. He says all it will do is raise insurance rates. “Our view remains unchanged: This rule is unlawful and fatally flawed, and it should have been withdrawn instead of finalized,” Eyles said.

Source link: Insurance Business America —

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