How health insurers game Medicare Advantage ratings to boost bonus payments

Humana, UnitedHealth, Aetna, Anthem and other insurance companies that provide Medicare Advantage plans use a tactic known as "crosswalking" to collect additional revenue from the federal government, according to an analysis of federal data by The Wall Street Journal.

Here are five things to know.

1. Medicare ranks Medicare Advantage plans on a quality scale of one to five stars, and pays bonuses to plans with high ratings. When an MA plan is not set to receive a financial bonus, health insurance companies will merge those patients into plans with higher scores, which preserves the bonuses.

2. Using this tactic, health insurance companies are able to boost the ratings of Medicare Advantage plans without actually improving on quality measures.

3. Insurers have used this tactic over the past few years. Insurers shuffled roughly 1.45 million Medicare Advantage members into higher-rated plans for 2018, according to WSJ.

4. Paul Ginsburg, PhD, a professor at the University of Southern in Los Angeles and a member of the Medicare Payment Advisory Commission, told WSJ crosswalking "is nothing more than gaming the system."

5. The budget deal signed into law in February is expected to cut down on the practice of crosswalking, according to WSJ.

Read the full WSJ article here.

More articles on payer issues:

Cigna's stock price tumbles on news of deal with Express Scripts
2 senators call on HHS Secretary Alex Azar to probe Anthem's ED rules
UnitedHealth takes aim at costly ED visits with new policy: 5 things to know

© Copyright ASC COMMUNICATIONS 2018. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months