Medicare knows about $30 billion in overbilling but refunds prove elusive

Health insurers overcharging Medicare Advantage plan members for medical procedures, and therefore Medicare and U.S. taxpayers, is a common practice, according to Kaiser Health News. If questionable inflated billing issues are happening to the Federal Government, imagine what’s happening with your employer health plan. To protect your plans assets, consider using an independent TPA, get rights to audit large claims before paying them, look at Reference Based Pricing plans, and use Medxoom technology to help your employees navigate the healthcare system.

From OregonLive:

“Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone, but federal officials say they are moving ahead with long-delayed plans to recoup at least part of the money.

Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have.”

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