In the one area of the federal government’s program budgeting that demands a higher commitment to accuracy and accountability, the collective Medicare Advantage Plans programs show neither. In a years-long investigation, complete with mounting evidence at every turn, there are still countless cases of government overpay. Our seniors and elderly are the ones who shoulder the results from a lack of oversight.
The Centers for Medicare and Medicaid Services recently revealed that as far back as 2008, there have been a specific group of privately-run Medicare Advantage plans that are believed to be stealing from the government. In fact, they even have a special name: “high-flyers.” These high-flyers are stealing from every taxpayer in the country.
Even worse, there are only around 30 audits being conducted annually when CMS budgets allow for more than 80 audits each year. Instead, CMS proposed to the White House Office of Management and Budget that only the 30 audits be conducted. This means around 30 contracts, out of more than 600, face audits each year.
If this isn’t disturbing enough, CMS promised to complete audits from 2011 and begin recouping those overpayments by 2014. That has not happened. Now, it’s saying it “anticipates completing the audits in 2016”.
It wasn’t until the Center for Public Integrity sued under the Freedom of Information Act to gain access to those files that the truth came to light.
As many of our clients know, the Medicare Advantage plans, which are privately run, offer seniors an alternative to traditional Medicare. At the end of 2014, there were more than 17 million Americans who’ve chosen these plans. This equates to around one-third of those eligible for Medicare coverage.
The Center’s lawsuit has revealed what many are now saying is “widespread suspicions that some risk scores are being purposefully inflated”. While the FOIA served a purpose, what the Center received was thousands of heavily redacted documents and close to 1500 were blacked out in their entirety. This includes the names of health plans and how much they were overpaid. Those familiar with the investigation are saying there is too much secrecy surrounding the audit and the lack of effort to stop the overpayments. In fact, Senate Judiciary Committee Chairman Charles Grassley said, “The agencies are responsible for getting the payments right in the first place and pursuing full refunds of all over-payments for the taxpayers. They have an obligation to be as transparent as possible about audits, over-payments and everything else in the public interest about a taxpayer-funded program.”
What was available in the documents are details that reveal taxpayers are paying far more for the audits than what they’re receiving as a result of the audits.
As estate planning lawyers, we understand the budgetary struggles seniors face. No one’s purpose is served when so much waste occurs with no oversight and no interest in correcting the problems. It’s time for a more aggressive effort by decision makers. We hope it comes sooner rather than later.