Medicare Advantage

A civil suit filed by the Justice Department this week links exaggerated patient bills to tens of millions of dollars in overcharges by Medicare Advantage plans. A data analytics team facilitated the fraud, the lawsuit alleges.

Health & Safety

The DOJ Says A Data Mining Company Fabricated Medical Diagnoses To Make Money

9:22pm September 14, 2021

by Fred Schulte

In a civil suit filed this week, the Justice Department accuses a New York medical analytics company of helping a Medicare Advantage plan cheat taxpayers out of millions of dollars.

Medicare Advantage, a fast-growing private alternative to original Medicare, has enrolled more than 26 million people. Humana Inc. is one of the largest of these insurers. While popular with seniors, Medicare Advantage has been the target of multiple gove

Health & Safety

Humana Inc. Overcharged Medicare Nearly $200 Million, Federal Audit Finds

9:15am April 20, 2021

by Fred Schulte

If the report by the U.S. Department of Health and Human Services' Office of Inspector General is sustained, Humana Inc. could face a record penalty for overcharges in a Medicare Advantage plan.

Health & Safety

Whistleblower Alleges Fraud At A Large Medicare Advantage Plan In Seattle

5:00am October 18, 2019

by Fred Schulte

As the Trump administration calls for expanding access to Medicare Advantage, a federal whistleblower lawsuit accuses a large Medicare Advantage plan of bilking Medicare out of $8 million.

While prescriptions for durable medical equipment, such as orthotic braces or wheelchairs, have long been a staple of Medicare fraud schemes, some alleged scammers are now using telemedicine and unscrupulous health providers to prescribe unneeded equipmen

Health & Safety

Phone Scammers And 'Teledoctors' Charged With Preying On Seniors In Fraud Case

5:01am October 07, 2019

by Victoria Knight

Officials warn that schemes devised to steal from Medicare have embraced telemedicine. One man was prescribed $4,000 of medical equipment he didn't need and never asked for.

Medicare Advantage health plans, mostly run by private insurance companies, have enrolled more than 22 million seniors and people with disabilities — more than 1 in 3 people who are on some sort of Medicare plan.

Journalists File Lawsuit To Force Feds To Release Medicare Advantage Audits

12:59pm September 27, 2019

by Fred Schulte

A lawsuit filed by Kaiser Health News under the Freedom of Information Act could spur the Centers for Medicare & Medicaid Services to release audits that document up to $650 million in overcharges.

The same steep growth and use of big data that attracted venture capital cash to companies that administer Medicare Advantage plans have led to scrutiny of the companies by government officials. Federal audits estimate such plans nationwide have overcharg

Health & Safety

Missouri Firm With Silicon Valley Ties Faces Medicare Billing Scrutiny

12:03pm July 23, 2019

A federal audit and a whistleblower lawsuit allege that Medicare Advantage plans from the St. Louis-based Essence Group Holdings Corp. have significantly overcharged taxpayers.

Medicare Advantage plans, administered by private insurance companies under contract with Medicare, treat more than 22 million seniors — more than 1 in 3 people on Medicare.

Health & Safety

Medicare Advantage Plans Overbill Taxpayers By Billions Annually, Records Show

3:08pm July 16, 2019

The federal government wants to deploy several new tools for catching insurers that have overcharged Medicare $30 billion in the past three years alone. But the insurance industry is balking.

The Social Security Administration didn't deduct premiums from some seniors' Social Security checks that were supposed to pay for Medicare Advantage and private drug coverage.

Health & Safety

Social Security Error Jeopardizes Medicare Coverage For 250,000 Seniors

3:50pm June 06, 2019

by Susan Jaffe

A billing glitch could cause lapses in private drug policies and Medicare Advantage plans that provide both medical and drug coverage. Premiums weren't deducted from some Social Security checks.

A business decision by UnitedHealthcare, the nation's largest health insurance carrier, to drop a popular fitness benefit has upset many people covered by the company's Medicare plans.

Health & Safety

UnitedHealthcare Customers Are Unhappy About Cuts To SilverSneakers Fitness Program

9:11pm December 04, 2018

by Judith Graham

Health insurer UnitedHealthcare plans to cut SilverSneakers, a popular fitness benefit, for 2.5 million people with the company's Medigap and Medicare Advantage coverage.

Services like rides to the doctor or wheelchair ramps are among those that some Medicare Advantage plans will begin to offer next year.

Health & Safety

New Medicare Advantage Benefits Are Supposed To Help Seniors Stay Out Of The Hospital

5:00am November 09, 2018

by Susan Jaffe

To help seniors stay healthy and independent, some Medicare plans will soon cover things like home-delivered meals or rides to the doctor, but finding plans that include the coverage is not easy.