The Centers for Medicare & Medicaid Services will be releasing 90 audits of Medicare Advantage plans that are expected to reveal hundreds of millions of dollars in overcharges to the government, according to Kaiser Health News. CMS is releasing the audits to settle a Freedom of Information lawsuit KHS filed against the agency a little more than three years ago.
“It’s incredibly frustrating that it took a lawsuit and years of pushing to make this vital information public,” Thomas Burke, a San Francisco attorney who represented KHN pro bono, said in an article published on the news service’s website.
As part of the agreement, CMS agreed to pay $63,000 to the law firm representing KHN and make a best effort to provide the documents within six weeks. Under the agreement, CMS did not admit to any wrongdoing in withholding the records.
KHN filed the suit in September of 2019 in U.S. District Court in San Francisco. The news service sought to obtain audits of MA plans conducted in 2011, 2012 and 2013. CMS officials have stated they expect to recover up to $600 million in overpayments from dozens of private insurers under scrutiny for potentially overcharging Medicare.
The government documents should provide an extensive look at the government auditing process known as Risk Adjustment Data Validation. To date, that program has had difficulty preventing MA plans from overcharging CMS.
MA plans have been under increased scrutiny in recent months as the popularity of the plans increases. Last spring, the Office of Inspector General accused MA organizations of denying or delaying services that met Medicare coverage and MA billing rules. In August, CMS published a Request for Information, asking the public to provide input regarding various aspects of MA plans. A number of home care organizations, including the National Association for Home Care and Hospice and the Partnership for Quality Home Healthcare urged CMS to ensure MA plans provide the same level of care as fee-for-service plans and release patients from hospitals to home healthcare in a timely fashion.
Currently 46% of Medicare-eligible seniors are enrolled in MA plans. That number is expected to exceed 50% within the next few years.