Medicare Advantage plans could have a problem with risk scores that are manipulated by insurers to get a higher reimbursement, according to a Bloomberg Business article. Experts says inflated risk scores cost Medicare $2 billion in 2014.
The estimate comes from Timothy Layton, an economist at Harvard Medical School who co-authored a recent paper on risk adjustment scores. He tells Bloomberg that the steep enrollment increase in Medicare Advantage plans has created opportunities for insurers to maximize reimbursement using consultants and software to uncover diagnoses that may be overlooked. Although this may not classify as outright fraud, whistleblower lawsuits, including one against the consulting company MedXM, have highlighted potential issues surrounding exaggerated or fabricated claims. Article