Journalists sue CMS to access Medicare Advantage audits

Journalists sued CMS Sept. 26 to get copies of dozens of Medicare Advantage audits, according to Kaiser Health News.

The complaint, filed in federal court, demands that CMS provide access to audits of Medicare Advantage health plans for 2011, 2012 and 2013, including audit spreadsheets.

KHN says senior correspondents Anna Maria Barry-Jester and Fred Schulte, while employed by the news service, requested access to the audits in July under the Freedom of Information Act, but CMS has still not publicized the requested information. 

The lawsuit alleges CMS is improperly withholding the audits, "even though CMS estimates that these audits have identified some $650 million in improper charges." 

According to KHN, CMS has disclosed the names of the health plans under close examination, but no other details.

"This action is about accountability for hundreds of millions of public dollars misspent," Elisabeth Rosenthal, KHN's editor-in-chief said in Mr. Schulte's report of the lawsuit. "The public deserves details about the overpayments, since many of these private companies are presumably still providing services to patients, and we need to make sure it can't happen again."

Medicare Advantage plans are offered through private insurance companies that have agreements with the federal government.

In July, KHN reported that Medicare Advantage health insurers have overcharged the federal government by almost $30 billion over several years and that federal officials were moving forward with plans to recoup some of the funds.

But federal officials have struggled to get money back, the news service reported, and a group of U.S. senators on Sept. 17 urged CMS to probe Medicare Advantage overbilling. 

In its recent lawsuit, KHN demands that CMS "immediately disclose the requested records" and "award KHN its reasonable costs and attorneys' fees."

CMS declined to comment on the lawsuit, citing pending litigation.

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