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Medicare Private Plans Got $2.6 Billion in Suspect Payments (1)

Sept. 10, 2020, 4:02 AMUpdated: Sept. 10, 2020, 6:28 PM

A government watchdog agency is urging the Trump administration to tighten its oversight of billions of dollars in potentially improper payments to private Medicare Advantage health plans that cover 24 million beneficiaries.

A new report by the Health and Human Services Office of Inspector General says the Centers for Medicare & Medicaid Services provided $2.6 billion in “risk-adjusted” payments to 438 Medicare Advantage plans in 2017 based on patient diagnoses that were unrelated to any other clinical services.

Eighty percent of these payments, or $2.08 billion, were generated through “health risk assessments” in which someone who’s usually uninvolved in the ...

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