How Much Fraud in Medicare Advantage?

How much fraud is there in the Medicare Advantage program?

James Cosgrove, who is heads of health care review for the Government Accountability Office (GAO) told the House Ways and Means Oversight Subcommittee that 10 percent of the payments under Medicare Advantage were “improper,” a sum that would have come to $16.2 billion in 2016.

As bad as Medicare Advantage accounting is, regular Medicare is worse, with an “improper payment” rate of 11 percent, or $41 billion down the drain in 2016.

Those these big numbers are cause for pause, additional concern is raised when we look at the response.

In an April 2016 report, GAO said CMS has spent about $117 million auditing Medicare Advantage since 2010, but recouped just under $14 million in total.  That sum includes the $3.4 million recovered after the agency found five Medicare Advantage plans ripping off taxpayers by some $128 million in 2007.

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