Congressman Doggett on Ending Medicare Advantage Waste, Fraud, and Abuse

Medicare Advantage Deceptive Advertising

• 📺 Medicare Advantage ads are often misleading, with current campaigns in Louisiana deceptively claiming Senator Cassidy's reforms will cut Medicare and deny access to doctors.
• ⚠️ These false ads aim to resist reforms that would end the practice of upcoding by Medicare Advantage providers.

The Cost of Medicare Advantage

• 💰 Medicare Advantage plans are paid tens of billions of dollars more annually than traditional Medicare for serving the same beneficiaries.
• 💸 Rationalizing the MA payment system and reinvesting savings could benefit both traditional Medicare enrollees and MA enrollees.
• 📉 The current MA status quo is inefficient, and even MA enrollees could be better off with reforms.

Addressing Upcoding and Risk Adjustment

• 🔍 Existing CMS methods for adjusting for higher coding intensity in Medicare Advantage are seriously inadequate, leading to higher-than-intended payments.
• 📊 Adopting a better risk adjustment formula, like the DESIE method recommended by MedPAC, could mitigate upcoding problems.
• ⚖️ Insurer-specific adjustments could target upcoding directly but might expand opportunities for favorable selection.

Supplemental Benefits in Medicare Advantage

• 🎁 While MA plans advertise extensive supplemental benefits like free rent or dental services, the actual coverage is often more limited than expected.
• 🧐 The additional benefits offered by MA plans are not commensurate with the additional money being paid to these plans.
• 💡 There may be better ways to deliver these additional benefits to Medicare beneficiaries than through higher MA payments.