Medicare Advantage Plans' Fraud Oversight Weak, Says OIG
One organization accounted for 78% of the total 1.4 million incidents of potential Part C and Part D fraud and abuse. Excluding the 95% of all reported incidents that were linked to three Medicare Advantage organizations, 134 organizations identified a total of 73,499 potential fraud and abuse incidents in 2009. Of those, 83% were linked to Part C. Those 134 organizations covered 9.9 million beneficiaries in 2009.
Size apparently was not a factor in organizations' ability to monitor waste and fraud. "For example, an organization with more than 250,000 enrollees identified 37 potential Part C fraud and abuse incidents and 8 potential Part D incidents. Another organization, which had fewer than 5,000 enrollees, identified 7,787 potential Part C fraud and abuse incidents and 154 potential Part D incidents," OIG said.
The 134 Medicare Advantage organizations reported 32 different types of Part C incidents in 2009. The most common related Part C was improper coding of services. The organizations identified 25 different types of potential fraud and abuse related to Part D, and inappropriate prescription dispensing was the most common.
John Commins is a senior editor with HealthLeaders Media.
- Senators Hear How Two-Midnight Rule Harms Patients, Hospitals
- 3 Management Lessons from a Supermarket Debacle
- Handshaking Spreads Germs. Get Over It.
- Healthcare Costs Start With What We Eat
- Hospitals Likely to Outsource ICD-10 at Launch
- IOM Identifies GME Problems, Calls for Finance Changes
- CMS Confirms ICD-10 Deadline
- Anatomy of 3 Health System Rebranding Efforts
- Premium Subsidy Fight Creating Uncertainty for Hospitals, Health Plans
- Medicare Advantage Carriers See 'No Choice' But to Accept Cuts