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Written by Reed Tinsley, CPA | February 20, 2007
Congress Considers Scrutiny of Medicare Advantage Overpayments and Benefits
Rep. Pete Stark (D-Calif.), chairman of the Ways and Means health subcommittee, signaled that Medicare Advantage plans would come under tougher congressional scrutiny and pressed the CMS to detail the extra benefits it claims beneficiaries receive under the program.
Stark said that the benefits likely are “nowhere near the value of overpayment” that the health plans currently get from federal reimbursement. During a congressional hearing yesterday, Stark chided CMS Acting Administrator Leslie Norwalk for presenting a federal budget that includes scaled-back payments to hospitals and physicians, but leaves the private plans that participate in Medicare Advantage untouched. Health economists say that Medicare Advantage plans are paid about 12% more per beneficiary than if that same individual were covered under a traditional fee-for-service plan.
But Norwalk defended the program, which enrolls 8.3 million beneficiaries. Norwalk countered that health plans under Medicare Advantage would see a $15.2 billion reduction over five years because of the proposed savings slated for Medicare Parts A and B, plus an additional $2.3 billion from other legislative adjustments. Norwalk also said in written testimony that it provides significant coverage for lower-income enrollees, adding that 57% of beneficiaries report income between $10,000 and $30,000. There are more than 44.6 million Americans overall covered by Medicare. -- by Matthew DoBias (Daily Dose at www.modernhealthcare.com)
