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Vast Majority of Private Medicare Advantage Plans Overcharged the Government

New analysis by the Center for Public Integrity of Medicare Advantage audits show that 35 of the 37 companies audited by the Centers for Medicare & Medicaid Services (CMS) overcharged the government by millions of dollars each year. By “upcoding” claims, insurance companies report patients as being sicker than they are and thus collect higher payments from Medicare. 

By overstating the severity of medical conditions like diabetes and depression, extra payments are made to health plans which claimed some diabetic patients also had complications of the disease, such as eye or kidney problems. After the CMS audits, these claims were ultimately reduced or invalidated in nearly half the cases, sometimes more.  This CPI report isn’t the first time private insurers in Medicare Advantage have come under fire. In May, a Government Accountability Office report called for “fundamental improvements” to curb excess charges linked to faulty risk scores.  In addition, at least half a dozen health-industry insiders have filed whistleblower lawsuits that accuse Medicare Advantage insurers of manipulating risk scores to boost profits.

CPI also found: 

Auditors on average could confirm just 60 percent of more than 20,000 medical conditions plans were paid to treat. The confirmation rates were much lower for some conditions, such as diabetes with serious complications, depression and some forms of cancer.

Overpayments triggered by unsupported medical diagnoses at the 37 plans audited topped $10,000 per patient for more than 150 patients. The health plans overcharged the government by $2,000 or more for at least 3,500 people in the 2007 sample group.

The health plans overall were three times as likely to charge Medicare too much as too little for some of the 70 medical conditions examined as part of the audits.

None of the plans faced closer scrutiny following the audits, no matter the size of the overpayment. The 2007 audits, which collected a total of $12 million in overpayments, are the only ones CMS has completed since officials adopted risk scores in 2004 at the behest of Congress. In some cases, health plans are still appealing the results, nine years later.  

17 million seniors are enrolled in Medicare Advantage and in 2014, Medicare paid the health plans more than $160 billion. The Center for Public Integrity reported that overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years.

Another Trump Whopper – This One on Social Security

Since immigration is a key issue for Donald Trump’s Presidential campaign, we knew it was only a matter of time before one of the biggest Social Security myths would work its way into campaign rhetoric – and so it has, in a new Trump for President campaign ad:

In Hillary Clinton’s America, “illegal immigrants … [are] collecting Social Security benefits, skipping the line.” –voice-over in a Donald Trump campaign ad, Aug. 19, 2016

As we’ve reported many, many times, undocumented workers do not receive Social Security benefits.  In fact, because they don’t have legal Social Security numbers what frequently happens is they end up contributing but not collecting:

“Stephen C. Goss, the chief actuary of the Social Security Administration, has reported that unauthorized immigrants contributed about $12 billion a year to Social Security, adding an estimated $300 billion over the years to the Social Security trust fund. During the most recent attempt to reform our immigration system in 2007, the Congressional Budget Office (CBO)estimated granting permanent status would generate $57 billion in additional revenue over a decade.”

Fact checkers took a look at the new Trump campaign ad and came to the same conclusion, earning Trump his 42nd “Whopper” ranking:

“The Republican presidential nominee makes a bizarre claim that undocumented immigrants will collect Social Security under a Clinton presidency. In general, people in the United States illegally are not eligible to collect Social Security benefits. They must be granted some type of lawful status — either by obtaining legal status or being granted deferred action. Even then, it’s not accurate to say they are “skipping the line.” People who obtain lawful status under DACA need to work for at least 10 years, pay taxes and reach retirement age before they are eligible to receive Social Security benefits.

Trump has already earned 41 Four-Pinocchio ratings. We would have liked to see the nominee finally stick closer to the facts in his first general-election ad. Unfortunately, this ad is — to borrow a line from its script — “more of the same.” The broad assertion in this ad is just not supported by facts, and thus earns Four Pinocchios.”

You can read more about what Immigration reform means for Social Security in our Issue Brief.  Here are some basics:

  • As legal status is granted to current undocumented immigrants, allowing workers to step out of the shadows, contributions to the Social Security program will increase. The CBO estimated that reform would increase the growth of the economy by as much as 1.3 percent.
  • Social Security trustees project that an increase in immigration of 100,000 persons a year would improve the long-term actuarial balance of the Social Security’s trust fund by about 3.5% of the projected 75-year deficit.
  • The immigrant population, in particular undocumented workers, is very young. In fact 59% arebetween 25 and 44 years of age. History has shown that their children, as legal second- generation Americans, would make measureable contributions to our nation and economy. A Pew research study of the 20 million adult U.S.-born children of immigrants shows that these adult children have median incomes and homeownership rates similar to the general U.S. population. In fact, second generation adult children of immigrants have a lower poverty rate and higher college graduation rates. All of these demographic factors are potentially good - not bad - news for Social Security.


Social Security Reverses Cell Phone Rule

Good news from the Social Security Administration today...it has reconsidered new security rules which required users of its online portal to confirm their identity via text.  Since only a quarter (27%) of adults ages 65 and older own smartphones, this decision makes perfect sense.  

The SSA website says: 

​​"We removed the requirement to use a cell phone to access your account. While it’s not mandatory, we encourage those of you who have a text capable cell phone to take advantage of this optional extra security. We continue to pursue more options beyond cell phone texting."

 NCPSSM has urged SSA acting Commissioner Carolyn Colvin to investigate using email or other forms of verification which are more accessible to Social Security beneficiaries. 

Happy Anniversary Social Security

For 81 years, Social Security has provided an economic lifeline to average Americans.  Without this vital program 41 percent of elderly Americans would live in poverty but with Social Security, only 10 percent of seniors are below the poverty line. Of course, Social Security serves more than just retirees.  People with disabilities, survivors, spouses and children also depend on the benefits earned through the program. 

American understand, first hand, how important Social Security is to their own economic security; however, Social Security’s economic contributions to communities, counties, and states continue to be misunderstood and often ignored in Washington’s fiscal debates.

In 2014 alone, Social Security delivered a $1.6 trillion fiscal boost nationwide as benefits were spent and cycled through the economy. A new online report by the National Committee to Preserve Social Security and Medicare Foundation provides a detailed look at the significant economic impact generated by Social Security benefits. Social Security Spotlight delivers data on beneficiaries by state, county, Congressional district, race/ethnicity, age and gender. 

Social Security Should Change New Cell Phone Security Rule

As we first reported last week, new federal online security rules have led the Social Security Administration to require all new and current account holders to SSA’s online portal,  my Social Security, to have a text-enabled cell phone to access their account online. 

Since only a quarter (27%) of adults ages 65 and older own smartphones this new rule is baffling.  NCPSSM President/CEO, Max Richtman, has urged Social Security’s Acting Commission, Carolyn Colvin, to change the new requirement:

We are concerned that the new authentication requirements will mean that millions of Americans will find themselves cut off from this convenient avenue of service delivery. That’s why we urge you to move quickly to protect seniors by expanding your authentication procedures to include options that can be used by those who do not have text-capable cell phones. One option would be to send an authentication code to mySocialSecurity account holders via email. Such an expansion would go a long way in ensuring that seniors will continue to be able to access their accounts.

We understand the dilemma SSA confronts in making individuals’ personally-identifiable information available to them through an online service portal such as mySocialSecurity.

“Too little security can compromise the privacy of millions of Americans. Authentication procedures that are overly-rigorous or that offer too few options can close off an important avenue of service delivery and lead to increased phone and walk-in traffic in local Social Security offices. We urge you to review the new authentication procedures with the goal of striking the right balance between access and security. Establishing an authentication option based on email or a person’s landline telephone would significantly increase the number of account holders who would continue to have access to the services that mySocialSecurity so admirably provides.”

You can read our entire letter here





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(202) 216-8378
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Walter Gottlieb
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(202) 216-8414

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