washington – The Biden administration estimated Monday that it could collect as much as $4.7 billion in fines from insurers and impose harsher penalties if they file improper charges on taxpayers’ Medicare Advantage care tabs.
Federal regulators have been warning for years about dubious charges for the government’s private version of health insurance plans, with investigators suggesting insurers may be defrauding taxpayers of billions of dollars each year by claiming members are sicker than they really are. Receive inflated payments.
HHS said it would begin billing insurers when an audit found that insurers were billing for diagnoses that were not reflected in patients’ medical records. For more than a decade, the government has not sought refunds for those payments, the agency said.
“Today, we are taking some long overdue steps that move us in the direction of accountability,” HHS Secretary Xavier Becerra said on a call with reporters Monday.
Those fines are expected to pay back $4.7 billion over the next decade, the agency estimates.
The payments in question were submitted through Medicare Advantage, a thriving program that accounts for nearly half of the 60 million people enrolled in Medicare. Medicare Advantage differs from traditional Medicare in that private companies offer plans that are reimbursed by the government. In total, the government spent $900 billion on health insurance last year.
As its popularity has risen, there have been growing concerns that insurers are extorting taxpayers by inflating patients’ conditions to get higher reimbursements from the government. In 2017, for example, the HHS Office of Inspector General issued payment warnings worth about $6.7 billion for patients whose diagnoses were not supported by medical records.
Insurers have been preparing to oppose the long-awaited final rule, and company leaders have raised concerns about the accuracy of the audits. The move will raise insurance rates, warned Matt Eyles, president of the American Health Insurance Plan, a lobbying arm for health insurers.
“Our view remains the same: This rule is illegal and fatally flawed, and it should be revoked rather than finalized,” Eyles said.
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