After Abuse, HHS Finds Medicare Advantage Under Limited Review

Following a recent report that Medicare Advantage plans were overpaid an estimated $598 million in 2007, the HHS Office of Inspector General released a report today that found the private company charged with scouring certain Medicare claims for possible fraud focuses only a small portion of its efforts on the Medicare Advantage program.

CMS contracted Easton, Md.-based Health Integrity to investigate the $124 billion Medicare Advantage program, or Part C, and the prescription drug benefit, Part D. The OIG found 79 percent of Health Integrity’s nearly 2,300 fraud-finding investigations between 2010 and 2011 focused on Part D compared with 8 percent toward Part C.

Health Integrity shifted blame for its lopsided attention to CMS, which doesn’t grant the company access to Medicare Advantage’s central claims database to use for investigations, according to the report. Additionally, Health Integrity said unless law enforcement agrees to take on fraud cases, it lacks the authority to proceed with investigations.

After Abuse, HHS Finds Medicare Advantage Under Limited Review

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