Enrollment in Medicare Advantage (MA) plans has more than doubled over the past decade, and reached almost 27 million people in 2021 (close to half of all people on Medicare). Despite the growing popularity of MA among consumers, government watchdogs presented a number of criticisms to a House panel on June 28, 2022. Among the complaints were reports of plans denying access to healthcare based on limited provider networks and inappropriate determinations of “medical necessity”. The Medicare Advantage health assessments were also targeted by the watchdogs stating, “…(MA) health plans can profit from making patients look sicker on paper than they are.” They cited a report from 2017 in which Medicare paid $2.6 billion for health assessments, only to find 3.5 million members had no record of receiving any medical care for the conditions diagnosed / reported in those health assessments. CMS, which runs the $350 billion-a-year Medicare program, declined comment on this most recent hearing. Watchdogs noted that CMS has still not completed annual auditing of the MA plans as far back as 2011. CMS is scheduled to release audit results for 2011, 2012 and 2013 later this year.
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