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A doctor visits an older adult at his home. Photo: Mel Melcon/Los Angeles Times via Getty Images

The health insurance industry again is attacking federal proposals that would more aggressively audit Medicare Advantage claims for improper coding — audits that would save taxpayers upwards of $4.5 billion over the next decade.

The big picture: Medicare Advantage is the growth engine of the insurance industry, which has successfully delayed changes and neutered audits.

Between the lines: The audits, called "risk adjustment data validation," have created paranoia among insurers for years. The federal government created the audits as a way to make sure insurers' records of patients' diagnoses matched up to their medical records.

  • Medicare Advantage insurers have exaggerated diagnoses as a way to get higher payments from the federal government, costing taxpayers billions of dollars over the past decade.

Driving the news: The Centers for Medicare & Medicaid Services gave the industry until the end of August to send in more comments on a beefed-up auditing process. Insurers still hate everything about it.

  • America's Health Insurance Plans, the industry's primary lobbying group, told CMS 8 times in its comment letter to withdraw the entire rule.
  • The Blue Cross Blue Shield Association and several regional insurers criticized the idea of removing a formula that adjusted Medicare Advantage overpayments based on errors in the regular Medicare program.
  • Centene warned the audits could lead to more "market consolidation."

The Medicare Payment Advisory Commission again stood alone as a supporter of the government's auditing process.

What's next: Federal officials will make a final call on the auditing changes later this year, with the entire industry pressuring them to kill or substantially scale back their changes. It's possible insurers would take this to court if the changes go through.

Go deeper

Updated 2 hours ago - Technology

From Malcolm X to "Free Britney," new media shapes the justice system

Illustration: Shoshana Gordon/Axios

True crime documentaries, podcasts and social media campaigns are bringing new attention to real-world legal proceedings — and are often affecting the outcome.

Why it matters: New media platforms can instantly put a national spotlight on cases that have long been forgotten or buried under red tape.

Updated 4 hours ago - Health

The next big bottleneck in the global vaccination effort

Illustration: Rae Cook/Axios

The world still needs more coronavirus vaccines, but an additional bottleneck has emerged in many low-income countries: They need help getting shots in arms.

Why it matters: Increasing vaccination rates across the world is both a humanitarian necessity and the best way to prevent dangerous new variants from emerging, but it increasingly requires complex problem-solving.

Updated 5 hours ago - Health

COVID-19 Omicron variant cases identified in Europe, U.K.

People wearing masks walk in London on Nov. 25. Photo: Li Ying/Xinhua via Getty Images

Health officials in the United Kingdom, Italy and Germany announced on Saturday that they've detected the first known cases of the new COVID-19 Omicron variant.

Why it matters: The discoveries come as the world scrambles to respond to concerns over the new variant, discovered in South Africa earlier this week.