Medicare Advantage plans improperly denying claims

Medicare Advantage plans—which cover about one-third of all Medicare beneficiaries—are improperly denying medical claims to patients and physicians, according to The New York Times. MA plans are incentivized to deny claims to boost profits, the report alleges.

The NY Times article builds off the report from the HHS Office of Inspector General published at the end of September that revealed as much as 75 percent of claims denials are overturned when appealed.

The report comes as Medicare Advantage plans are expanding supplemental benefits in attempts to lure older Americans to enroll. Experts anticipate that MA plan enrollment will grow quickly over the next few years.

MA plans are required to provide at least the same benefits as traditional Medicare and are contracted with private healthcare companies. MA plans can save money by keeping patients healthy and reducing utilization of higher-cost settings, but they can also save money by denying care claims. CMS has stated it has not tried to steer beneficiaries away from traditional Medicare to the MA plans.

The practice of improperly denying claims can put patients at risk, as the beneficiary may go without the service, according to the NY Times.

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