
New MA Overpayment Study Points To Big Plans
A new risk adjustment study could lead to momentum to pass reforms I have written about Medicare Advantage (MA) risk adjustment (RA) overpayments before, but a new study has me thinking again whether the time really has come for RA reform. Many studies paint MA overpayments with a broad brush, saying the entire system is over-reimbursed. But a new study backs up something I have said for a long time – that a small number of larger MA plans receive a disproportionate benefit from these RA overpayment schemes by using aggressive or even fraudulent coding. The study by the Alliance of Community Health Plans (ACHP), a group that represents local and regional nonprofit payers, finds something similar to a few other studies that have zeroed in on the real culprits giving all of MA a bad name. ACHP’s study finds that UnitedHealthcare, the biggest MA insurer, collected up to $785