A week after Sen. Chuck Grassley (R-Iowa) called on the Department of Justice (DOJ) and the Centers for Medicare & Medicaid Services (CMS) to investigate fraud and abuse within Medicare Advantage plans, another senator from the other side of the aisle reaffirmed the need for improved federal scrutiny, according to the Center for Public Integrity (CPI).
In a letter to CMS Acting Administrator Andrew Slavitt, Sen. Claire McCaskill (D-Mo.), a top-ranking Democrat on the Senate Special Committee on Aging, called for a briefing on or before June 12, 2015 regarding "what CMS is doing to address the issue of inflated risk scores." McCaskill cited past reports that inflated risk scores within Medicare Advantage plans have led to widespread fraud and abuse. CPI previously reported that Medicare overpaid $32 billion between 2008 and 2010 because of inflated risk scores.
Humana revealed earlier this year that the DOJ is investigating risk scores assigned to Medicare Advantage beneficiaries and later indicated that the investigation may include other private insurers that offer Medicare Advantage plans, FierceHealthPayer: AntiFraud previously reported. So far this year, at least six whistleblower lawsuits allege misconduct associated with the privately run plans, and more are expected in the coming months.
"Time and again we've seen whistleblowers allege outright fraud when it comes to risk scores, and to me that's a sign there's simply not enough oversight taking place," McCaskill told CPI.
Medicare Advantage plans have been a focal point for the Government Accountability Office (GAO) for a number of years. In March, a GAO report found that improper payments to Medicare Advantage plans reached $12 billion in 2014, up from $5.1 billion between 2010 and 2012. In November, the Office of the Inspector General (OIG) said it would closely scrutinize Medicare Advantage plans for signs of fraud and abuse.