Medicare Advantage Reforms Delayed Amid Lobby Pressure
The Biden administration has delayed proposed rule changes aimed at cracking down on fraud in the Medicare Advantage program after the insurance industry lobbied against them. The changes involve tweaks to the Medicare Advantage risk-adjustment model, which determines how much the federal government pays insurers to cover patient care. Medicare Advantage plans are notorious for piling on diagnoses to make patients appear sicker than they are to reap larger payments from the federal government. CMS estimates that overpayments to Medicare Advantage totaled $11.4 billion in fiscal year 2022. The Biden administration will phase in the changes over a three-year period, a concession to large insurers that dominate the Medicare Advantage market.