Becker's Healthcare July 8, 2024
Medicare Advantage plans received $50 billion in payments between 2018 and 2021 for diagnoses insurers added to medical records, a Wall Street Journal investigation published July 8 has found.
The Journal investigated billions of Medicare Advantage records and found that some conditions were diagnosed at a much higher rate among Medicare Advantage beneficiaries than among traditional Medicare beneficiaries. For example, diabetic cataracts were diagnosed much more often among Medicare Advantage beneficiaries than among traditional Medicare beneficiaries, the Journal found.
The federal government pays Medicare Advantage plans a rate per beneficiary based on their diagnoses.
CMS does not reimburse MA plans for beneficiaries with non-diabetic cataracts, a common condition among older adults, according to the Journal. The government does reimburse for...
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