Tag Archives: Medicare Advantage

I have been hitting the issues with FFS Medicare vs Medicare Advantage hard. Primarily, Medicare Advantage is draining Medicare funding due to the $billions being spent due to over-coding. Twelve $billion of over-coding charges in 2020. Another $15 billion of over-coding charges in 2021. CEOs are raking in higher salaries due to the preferential treatment the Medicare Advantage plans receive from Congress and CMS. Over-coding is just one of the...

It has taken years for the Feds, CMS, MedPac, Congress to catch up with the thieving practice of these healthcare plans. They have mislead the people they sell these plans too with come-ons such as health club ss, etc. Then when it comes time for care, it is delayed or denied. This comes after the plans already have received funding. It is about time Congress did something other than bicker. NYT could have been tougher . . . Medicare Delays...

Kip Sullivan has been writing about the issues with Medicare Advantage. I have joined with Kip in bringing the issues of Medicare Advantage to the forefront. Angry Bear has featured Kip and I have added to the dialogue. This next commentary details how Healthcare Insurance, mostly Medicare Advantage has been using artificial intelligence in the form of an algorithm to limit treatment or deny coverage. STAT Investigation has been providing the detail...

This article is easy reading exploring some the differences and why people may choose one plan over the other plan. Attached is also a Commonwealth Fund article with more detail. Medicare Plan Commissions May Steer Beneficiaries to Wrong Coverage, MedPage Today, Cheryl Clark. Agents and brokers selling Medicare plan coverage often steer their clients to a Medicare Advantage (MA) plan because it earns them a higher commission compared with a...

Part Two explores where Medicare should be going forward as determined by doctors Richard Gilfillan and Donald M. Berwick. It is an endorsement of the ACO model with changes to it creating greater efficiency. I am not so sure Kip Sullivan would endorse this approach as opposed to Single Payer. Ultimately Single Payer is less costly when we consider the elimination of much of the administration effort. There is another post I will be putting up when I...

And the news Media is waking up to this? In December 2022, NPR wrote, “Medicare Advantage plans overcharged Medicare by millions,” Health News : NPR Citing an April 26, 2016 example of US government auditors asked a Blue Cross Medicare Advantage health plan in Minnesota to turn over medical records of patients treated by a podiatry practice whose owner had been indicted for fraud. Medicare had paid the Blue Cross plan more than $20,000 to...

Medicare Advantage Over Payments In the conclusive summation of the latest KFF report on Medicare Advantage Healthcare plans which KFF also has in place, is this: Historically, one goal of the Medicare Advantage program was to leverage the efficiencies of managed care to reduce Medicare spending. However, the program has never generated savings relative to traditional Medicare. In fact, the opposite is true. As a result, Medicare Advantage...

A good article on hospital increasing healthcare costs, due to consolidations, supplies, and the associated hospital operational management. The article also engages in a book review of Big Med by David Dranove and Lawton Robert Burns (“Megaproviders and the High Cost of Health Care in America“). I will have to check the book out and advise later. Towards the end of the article, Shannon has included elements of Single Payer in her review-critique...

Introduction: FFS Medicare Overhead costs are ~2%. Medicare Advantage overhead costs are far higher. The same can be said for commercial healthcare costs paid by insurance companies. Neither MA administered healthcare or commercial insurance plans can compete with FFS Medicare for costs and care. I will touch on a few reasons why on Medicare at the end of this article which came by way of Dale Coberly, the resident expert of today’s SS. As...

Introduction: Before I get started on the main text of Kip’s expert article, I wish to point out something which is happening nationally. There is a plan afoot of forcing people into Value-Based Payment plans from traditional Medicare. The players include Iora Health (subsidiary of One Medical), Privia, General Catalyst, agilon health, Caravan Health, Signify (CVS owned), Village MD (Walgreens owned), Premier, etc. This is being done in...