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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

Caitlin Owens, author of Vitals
3 hours ago - Health

Biden taps ex-FDA chief to lead Operation Warp Speed amid rollout of COVID plan

Photo: Alex Wong/Getty Images

President-elect Joe Biden has picked former FDA chief David Kessler to lead Operation Warp Speed, a day after unveiling a nearly $2 trillion pandemic relief plan that includes $400 billion for directly combatting the virus.

Why it matters: Biden's transition team said Kessler has been advising the president-elect since the beginning of the pandemic, and hopes his involvement will help accelerate vaccination, the New York Times reports. Operation Warp Speed's current director, Moncef Slaoui, will stay on as a consultant.

The case of the missing relief money

Illustration: Sarah Grillo/Axios

A chunk of stimulus payments is missing in action, thanks to a mix up that put as many as 13 million checks into invalid bank accounts.

Why it matters: The IRS (by law) was supposed to get all payments out by Friday. Now the onus could shift to Americans to claim the money on their tax refund — further delaying relief to struggling, lower-income Americans.

The post-Trump GOP, gutted

McConnell (L), McCarthy (R) and Trump. Photo: Erin Schaff-Pool/Getty Images

Republicans will emerge from the Trump era gutted financially, institutionally and structurally.

The big picture: The losses are stark and substantial.