ST. PAUL, Minn. — CCHF Statement on HHS OIG audit of Aetna, which found millions of dollars in Medicare Advantage overpayments:
“As recent HHS OIG reports show, health plans expose taxpayers to fraudulent behavior and patients to deleterious denials of care. Health plans have upcoded the health status of Medicare patients to get higher federal payments, and they’ve denied medically necessary care to Medicare and Medicaid patients. Both actions lead to higher profits.
“A recent federal audit of Aetna shows that the records submitted by Aetna did not match the diagnoses in 73.8% of the cases. The HHS Office of the Inspector General estimates at least $25.5 million in overpayments to Aetna over just two years, 2015 through 2016. Similarly, in 2021, the OIG found some Medicare Advantage corporations using health risk assessments to drive payments higher.
“Meanwhile, these government-favored corporations are denying access to medical care. Since at least 2018, the HHS OIG has published reports of Medicare Advantage plans denying medically necessary care to senior citizens by refusing provider requests for payment or by denying prior authorization requests.
“Medicare Advantage plans are milking American taxpayers for all they can get while denying necessary care to those who are sick, injured, or dying. It appears the federal government and Congress are unwilling to stop this egregious exploitation of taxpayers and patients. Congress should act by repealing the Medicare Advantage program.”
2023 REPORT: https://oig.hhs.gov/oas/reports/region1/11800504.pdf
2022 REPORT: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp
2021 REPORT: https://oig.hhs.gov/oei/reports/OEI-03-17-00474.pdf
2019 REPORT: https://oig.hhs.gov/oei/reports/oei-03-17-00470.pdf
2018 REPORT: https://oig.hhs.gov/oei/reports/oei-09-16-00410.pdf