Dec 12, 2019

Federal auditor renews concerns of Medicare Advantage gaming

Medicare Advantage plans almost always add new patient diagnoses. Photo: Jeffrey Greenberg/Universal Images Group via Getty Images

A new federal audit presents more evidence that private Medicare Advantage plans are fudging the data about how sick their customers are, as a way to pull in more taxpayer dollars.

Details: Medicare Advantage plans received $6.7 billion in federal funding in 2017 based on diagnoses — like cancer or heart disease — that were not reflected in the actual care patients received, according to the report from the Office of Inspector General.

Go deeper: The war over Medicare Advantage audits heats up

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Private insurance's costs are skyrocketing

Reproduced from Kaiser Family Foundation; Chart: Axios Visuals

The cost of private health insurance is out of control, compared to Medicare and Medicaid. You see that clearly if you take a long-term view of recently released federal data on health spending.

Why it matters: This is why the health care industry — not just insurers, but also hospitals and drug companies — is so opposed to proposals that would expand the government's purchasing power. And it’s why some progressives are so determined to curb, or even eliminate, private coverage.

Go deeperArrowDec 16, 2019

The medications that are thrown away

Data: Centers for Medicare & Medicaid Services; Table: Axios Visuals

Last year, Medicare paid for $725 million worth of expensive medications administered in outpatient clinics — things like chemotherapy drugs — that ended up being discarded, according to new data released by the federal government.

Why it matters: Although that amount is just 2% of what Medicare paid for those types of infusion drugs, that's still a "very astonishing amount of waste," said Rena Conti, a health economist at Boston University who has studied the issue.

Go deeperArrowJan 6, 2020

The health care industry's happy holidays

Illustration: Eniola Odetunde/Axios

The year-end spending bill in Congress epitomizes the power of health care interests.

The big picture: There are lots of goodies for the industry, while patients will get the worst kind of holiday surprise — more medical bills.

Go deeperArrowDec 20, 2019