Humana, Cigna and Aetna led a pack of more than 30 Medicare Advantage plans that received overpayments from the government, according to a report in Kaiser Health News. A series of 90 government audits found the Centers for Medicare & Medicaid Services overpaid the plans approximately $12 million between 2011 and 2013.
Humana led the plans, receiving $2.97 million in overpayments; followed by Cigna with $1.74 million in overpayments; and Aetna with $1.27 million in overpayments. The audits also found that nine plans were underpaid by the government during that period. Those plans were primarily smaller, regional MA plans.
CMS agreed to release the audits last fall, following a Freedom of Information settlement with Kaiser. The agency said in 2018 that it plans to recoup an estimated $650 million from the plans, but the actual amount is still far from certain.
CMS pays MA plans more for members who are sicker compared to those who are healthier. However, previous audits often could not confirm which patients had the required conditions that demanded higher payments.
MA plans — which often include supplemental benefits for home health, transportation and meals — are growing in popularity among older adults. The plans are expected to make up more than half of the Medicare market within the next couple of years. But the plans have also been coming under increased scrutiny in recent months by government watchdogs.
Last year, the Office of Inspector General accused MA plans of delaying or denying services covered under Medicare. Last fall, a Senate committee issued a report claiming the private plans use bully tactics and aggressive marketing to enroll seniors.
CMS has also been gathering public input about the plans. Some provider organizations have called on the plans to provide care the same level of care that traditional fee-for-service Medicare plans provide.
