Medicare Advantage is a fast growing alternative to traditional Medicare coverage run mostly by private insurance companies. These health plans have enrolled about a third of people eligible for Medicare at an annual cost to taxpayers of about $150 billion. For most of the past decade, these health plans have been paid based on a formula known as a “risk score” that is supposed to pay higher rates for sicker patients and less for those in good health. In 2014, the Center for Public Integrity used government data to show that risk scores in many health plans were rising far faster than the norm. The series strongly suggested that the plans were “upcoding,” or exaggerating how sick many patients were to boost their revenues. In 2015, we uncovered numerous previously-secret audits and other documents that revealed for the first time how some health plans had overbilled the government by billions of dollars and largely gotten away with it.
