Fred Schulte, KFF Health News
KFF Health News has sued the U.S. Department of Health and Human Services Office of Inspector General to compel it to launch a spread of Medicare Advantage well being plan audits and different monetary data.
The suit, filed Nov. 12 in U.S. District Court in San Francisco beneath the Freedom of Information Act, or FOIA, seeks paperwork from the HHS inspector normal’s workplace, which acts as a watchdog over federal medical insurance applications run by the Centers for Medicare & Medicaid Services.
The go well with asks for correspondence and different data of contact between HHS officers or their representatives and Medicare Advantage organizations regarding overpayment audit findings and potential monetary penalties.
It additionally seeks data reflecting communication between HHS and CMS officers concerning the federal government’s insurance policies for recovering overpayments found throughout Medicare Advantage audits, together with a controversial decision in January 2023 to restrict greenback recoveries for audits courting again a decade or extra.
Additionally, the go well with seeks copies of presidency contracts awarded to exterior companies which have performed Medicare Advantage audits, together with budgets and efficiency evaluations, courting to 2020. In these audits, reviewers take a pattern of 200 sufferers from a well being plan and decide whether or not medical data assist the diagnoses the federal government paid well being plans to deal with.
KFF Health News requested the data in August, however, greater than two months later, “no documents, responsive or otherwise, have been produced,” the go well with says.
Sam Cate-Gumpert, an lawyer with Davis Wright Tremaine, which is representing KFF Health News professional bono within the case, stated the data is “critically important to public oversight of government misspending.”
According to the go well with, the inspector normal’s workplace has audited the Medicare Advantage program greater than three dozen occasions since 2019, revealing billions of {dollars} in overpayments.
But authorities officers haven’t recouped the overcharges, in response to the go well with.
The HHS Office of Inspector General “has left taxpayers footing the bill for billions of dollars in overpayments — even though HHS OIG’s primary purpose is to combat fraud and waste in Medicare and other federally funded health programs,” the go well with alleges.
“In fact, taxpayers have been forced to pay for the Medicare Advantage program’s wasteful spending twice — first, because of the program itself, and second, because of the costs of the audits, which the government spends millions of dollars to conduct,” in response to the go well with.
Medicare Advantage, largely run by personal insurance coverage corporations, has enrolled greater than 33 million seniors and other people with disabilities, greater than half of individuals on Medicare.
But this system has confronted criticism that it prices billions of dollars more than it should with analysis displaying that many well being plans exaggerate how sick sufferers are to spice up funds.
A FOIA lawsuit filed by KFF Health News in September 2019 prompted CMS to release summaries of 90 Medicare Advantage audits revealing thousands and thousands of {dollars} in overpayments. As a part of a settlement, CMS paid $63,000 in KFF Health News’ authorized charges, although it didn’t admit to wrongfully withholding the data.
The HHS Office of Inspector General had no instant touch upon the go well with.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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