Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.
The Center for Public Integrity is suing the Department of Health and Human Services to obtain a variety of oversight and investigation documents for Medicare Advantage plans, after the group's Freedom of Information Act requests have languished for more than a year.
With nearly 16 million Medicare beneficiaries -- nearly one third of all seniors -- enrolled in the Medicare Advantage program, annual costs are approaching $150 billion, increasing the potential for spending errors and overpayments while attracting the probing eyes of consumer watchdog groups like the Center for Public Integrity.
"The information about Medicare Advantage that we are asking for should be readily available to the taxpaying public," said Bill Buzenberg, the Center's executive director, in a media release. "There's no excuse for ignoring our request."
Last year, the group filed an extensive Freedom of Information Act request seeking documents on Medicare Advantage investigations, reports, audits and correspondence related to "effects of electronic health records and other digital billing systems on medical coding," "overpayments related to risk scoring," "data showing annual risk scores of Medicare Advantage patients by plan since 2004," and "records designating Medicare Advantage plans as 'high risk' providers."
HHS's Centers for Medicare & Medicaid Services responded to the group last June, but has since been non-responsive, according to the lawsuit.
This is the second time the Center for Public Integrity has sued HHS in a dispute over making public Medicare records. The first case involved billing records for doctors and hospitals reimbursed through the Medicare fee-for-service program, which eventually led to the release of physician payment data that continues to make headlines and divide regulators and medical experts.
The suit over Medicare Advantage could lead to a data dump of similar significance and bring new public interest to the program -- at the same time that it is more popular than ever with seniors but still under fire from critics who see it as more expensive than fee-for-service.
Medicare Advantage insurers, from Humana to regional Blues, could find themselves defending a decade's worth of financial outcomes even as they contend with declining rates.