Medicare Advantage Plans' Fraud Oversight Weak, Says OIG
Federal inspectors are calling for tighter oversight of waste, fraud, and abuse in Medicare Advantage after a first-ever system-wide audit of the program found wide disparities in vigilance and reporting among the privately run plans.
"Our findings indicate that Medicare Advantage organizations lack a common understanding of key fraud and abuse program terms and raise questions about whether all Medicare Advantage organizations are implementing their programs to detect and address potential fraud and abuse effectively," the report said.
The audit from the Department of Health and Human Services Office of Inspector General reviewed 2009 data from 170 of the 188 Medicare Advantage organizations that represented 4,547 plans nationwide and accounted for 94% of the 10.9 million Medicare Advantage beneficiaries in 2009.
The audit did not name the Medicare Advantage organizations.
Three Medicare Advantage organizations identified 95% of the 1.4 million incidents related to their Part C health benefits and Part D drug benefits that year, while 19% of the organizations reported no potential fraud and abuse. Overall, Medicare Advantage plans sent only 2,656 referrals of potential fraud and abuse for further investigation.
- The Secret to Physician Engagement? It's Not Better Pay
- Two-Midnight Rule Must be Fixed or Replaced, Say Providers
- Yale New Haven Health Partners with Tenet Healthcare in CT
- Don't Underestimate Emotional Intelligence
- Care Coordination Tough to Define, Measure
- 4 Reasons PCMH Principles Aren't Going Away
- Size Matters in Antibiotic Overuse
- Evidence-Based Practice and Nursing Research: Avoiding Confusion
- CDC Warns of Antibiotic Overuse in Hospitals
- SCOTUS Review of NC Board Case 'A Very Big Deal' to Providers