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Critics warned of billing abuse in Medicare Advantage health plans, but oversight is lagging

Why Medicare Advantage costs taxpayers billions more than it shouldRegulators have kept problems secret, and there’s no fix in sight By Fred SchulteDavid DonaldErin Durkin, June 4, 2014.

“Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year. Many seniors choose the managed-care Medicare Advantage option instead of the traditional government-run Medicare program because it fills gaps in coverage, can cost less in out-of-pocket expenses and offers extra benefits, such as dental and eye care. But billions of tax dollars are misspent every year through billing errors linked to a payment tool called a “risk score,” which is supposed to pay Medicare Advantage plans higher rates for sicker patients and less for those in good health. Government officials have struggled for years to halt health plans from running up patient risk scores and, in many cases, wresting higher Medicare payments than they deserve, records show.”

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