Introduction

U.S. Senator Claire McCaskill wants federal officials to step up oversight of privately-run Medicare Advantage health plans treating the elderly, citing allegations by whistleblowers that some health plans are overcharging the government for their services.

It is the second recent call by a U.S. Senator for enhanced scrutiny of billing practices in the popular private health plans, which treat more than 16 million seniors.

Last week, Senate Judiciary Committee Chairman Charles E. Grassley asked Attorney General Loretta Lynch to tighten scrutiny of Medicare Advantage health plans suspected of overcharging the government, saying billions of tax dollars are at risk as the senior care program grows.

Both McCaskill, a Missouri Democrat, and Grassley, an Iowa Republican, cited concerns over the accuracy of a billing tool called a “risk score,” which is intended to pay Medicare Advantage insurers higher rates for taking sicker people and less for those with few medical needs.

But federal officials have struggled for years to track overspending tied to inflated risk scores that prompt overbilling. A 2009 agency study found that some plans had exaggerated how sick patients were to boost their payments, for instance. CMS also has acknowledged that faulty risk scores remain a costly problem, as the Center for Public Integrity first reported last year.

In a May 26 letter to CMS administrator Andrew Slavitt, McCaskill asked for a briefing on steps the government is taking to combat risk scoring fraud and abuse.

“With fraudulently inflated risk scores potentially costing taxpayers billions of dollars every year and resulting in less money in the Medicare Trust Funds for our seniors, this is an issue that must be investigated further,” McCaskill wrote.