Наскоро публикувани федерални одити разкриват широко разпространени надценки и други грешки в плащанията за здравни планове Medicare Advantage за възрастни хора, като някои планове надхвърлят правителството над 1000 долара средно на пациент на година.
Обобщенията на 90-те одита, които изследваха фактури от 2011 до 2013 г. и са последните завършени ревизии, бяха получени изключително от KHN чрез тригодишно съдебно дело за FOIA, което беше Заселен в края на септември.
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kAmr | $A2:5E96C6>2:?:? 8 A = 2? DE=:EE=6 @? 2G6C286[ 2?JH96C6 7C@> Sg E@ Sffb A6C A2E:6?E]к^ам
kAmpF5: E@CD7=28@G6CA2J>6? ED H96? 2 A2E:6? E’D C64 @ C5D 72: = E @ 5 @ 4F > 6? E92E E96 @ A6CD? 925 E96 > 65:42 = 4 @? 5: E: @? E96 8 @ G6C?> 6? E A2: 5 E96962 = E9 A = 2? E @ EC62E[ @C :7 >65:42= C6G:6H6CD ;F586 E96 :==?6DD 😀 =6DD D6G6C6 E92? 4=2:>65]к^ам
kAm%92E92AA6? 65 @? 2G6C286 7@C; FDE @ G6C a_T @ 7 > 65: 42 = 4 @ ? 5: E: @? D 6I2>:? 65 @ G6C E96 E9C66 \ J62C A6C: @ 5j C2E6D @ 7 F? 4 @? 7: C>65 5: D62D6D H6C6 9: 896C:? D @ > 6 A = 2? D]k^Am
kAmpD | 65: 42C6 p5G2? E286’D A @ AF = 2C: EJ 2 > @ ? 8 D6?: @ CD 92D 8C @ H?[ r|$ 92D 7@F89E E@ <66A :ED 2F5:E AC@465FC6D[ 2?5 E96 >@F?E:?8 =@DD6D E@ E96 8@G6C?>6?E[ =2C86=J F?56C HC2AD]к^ам
kAm%92E 2AAC @ 249 92D 7CFDEC2E65 3 @ E9 E96:? 5FDECJ[ H9:49 92D 3=2DE65 E96 2F5:E AC@46DD 2D “72E2==J 7=2H65” 2?5 k2 9C67lQ9EEADi^^29:A@C8\AC@5F4E:@?]Db]2>2K @? 2HD]4 @ > ^ 5 @ 4F > 6? ED^pwx! 0 # ps’04 @ >> 6? ED0ux}p{0g0af]A57Qm9@A6DE@E@CA65@:Ek^2m[ 2?5 |65:42C6 25G@42E6D[ H9@ H@CCJ D@>6 :?DFC6CD 2C6 86EE:?8 2H2J H:E9 C:AA:?8 @77 E96 8@G6C?>6?E]к^ам
kAm “pE E96 6? 5 @ 7 E96 52J[ :E’D E2IA2J6C 5@==2CD E92E H6C6 DA6?E[” D2:5 s2G:5 {:AD49FEK[ 2 D6?:@C A@=:4J 2EE@C?6J H:E9 E96 r6?E6C 7@C |65:42C6 p5G@424J] “% 96 AF3 =: 4 56D6CG6D> @ C6: ? 7 @ C> 2E: @ ? 23 @ FE E92E]” k^am
CAMBI = 62DE E9C66 A2CE: 6D[ :?4=F5:?8 zw}[ 92G6 DF65 r|$ F?56C E96 uC665@> @7 x?7@C>2E:@? p4E E@ D92<6 =@@D6 56E2:=D 23@FE E96 @G6CA2J>6?E 2F5:ED[ H9:49 r|$ 42==D #:D< p5;FDE>6?E s2E2 ‘2=:52E:@?[ @C #ps’]к^ам
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kAmzw} k2 9C67lQ9EEADi ^^ <9?]@C8^? 6hd^ <9؟ \ 7: = 6D \ = 2HDF: E \ E @ \ 7 @ C46 \ 765D \ E @ \ 5: D4 = @ D6 \> 65: 42C6 \ 25G2? E286\2F5:ED^QmDF65r| $k^2m:? $6AE6>36C a_`h 27E6C E96286? 4J 72: = 65 E @ C6DA @ ? 5 E @ 2 u ~ xp C6BF6DE 7 @ C E96 2F5: ED]&? 56C E96 D6EE = 6>6? д[ r|$ 28C665 E@ 92?5 @G6C E96 2F5:E DF>>2C:6D 2?5 @E96C 5@4F>6?ED 2?5 A2J Seb[___ 😕 =682= 766D E@ s2G:D (C:89E %C6>2:?6[ E96 =2H 7:C> E92E C6AC6D6?E65 zw}] r | $5:5?E25>:EE@HC@? 87F == JH: E99 @ = 5:? 8 E96 C64 @ C5D]k^Am
kAmw: 89 4 @ 56CDk^am
kAm |DE @ 7 E96 2F5: E65 A = 2? D 76 ==:? E@H92Er| $42 == D2″ 9:894@5:?8:?E6?D:EJ8C@FA]”%92E>62?D E96J H6C62>@?8E96>DE 288C6DD: G6:?D66 <:؟ 8 6IEC2 A2J> 6? ED 7 @ C A2E: 6? ED E96J 4 = 2: > 65 H6C6 D: 4 <6C E92؟ 2G6C286]٪ 96 8 @ G6C؟> 6? E A2JD E96 962 = E9 A = 2? D FD:? 8 2 7 @ C > F = 2 42 == 65 2 „C: D
kAmqFE @ 7E6? > 65:42 = C64 @ C5D DFAA =: 65 3J E96 962 = E9 A = 2? D 72: = 65 E @ DFAA @ CE E9 @ D6 4 = 2: > D]&? DFAA @ CE65 4 @? 5: E: @? D C2? 865 7C@>5: 236E6DE@4@? 86DE: G6 962CE 72: = FC6]k^Am
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kAm |DE @ 7 E96 2F5: E65962 = E9 A = 2? D925`_[___ >6>36CD @C >@C6[ H9:49 D92CA=J 3@@DED E96 @G6CA2J>6?E 2>@F?E H96? E96 C2E6D 2C6 6IEC2A@=2E65]к^ам
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kAm &?: E65w62 = E942C6 2? 5wF > 2? 2[ E96 EH@ 3:886DE |65:42C6 p5G2?E286 :?DFC6CD[ 244@F?E65 7@C ae @7 E96 h_ 4@?EC24E 2F5:ED @G6C E96 E9C66 J62CD]к^ам
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kAm &?: E65w62 = E942C6 DA @ <6DA6CD @؟ w62E96C $ @ F = 6 D2: 5 E96 4 @> A2? J H6 = 4 @ > 6D “E96 AC @ 8C2 > @ G6CD: 89E E92E #ps’ 2F5: ED AC @ G: 56]” qFE D96 D2: 5 E96 2F5: E AC @ 46DD? 665D E@4@> A2C6| 65: 42C6 p5G2? E286 E@C:8:? 2 = | 65:42C6E@AC@G:562″4@>A=6E6 A:4EFC6”@7@G6CA2J>6?ED]”%9C66J62CD28@H6>2562C64@>>6?52E:@ ?E@r|$ DF886DE: ?8 E92E E96J 4 @ ?5F4E#ps’ 2F5: ED @ ?6G6CJ a=2 ?[ 6G6CJ J62C[” $@F=6 D2:5]к^ам
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kAm%96u=@C:52wF>2? 2 A = 2? 2 = D @ H2D E96 E2C86E @ 7 2 ? F? C6 = 2E65 2F5: E:? pAC: = a_a` 3J E96 w62 = E9 2? 5wF > 2? $6CG: 46D:? DA64E @ C86? 6C2=]%92E2F5:E[ H9:49 4@G6C65 3:==:?8D 😕 a_`d[ 4@?4=F565 wF>2?2 :>AC@A6C=J k2 9C67lQ9EEADi^^<9?]@C8^? 6HD^2CE: 4 = 6^9F>2? 2 \ 962 = E9 \ A = 2? \@G6C492C865\>65:42C6\3J\? 62C = J \ a __ \>: ==: @ ? \ 7656C2 = \ 2F5: E \ 7:? 5D^Qm4@ == 64E65? 62C=J Sa__>:==: @? k^2m E92E J62C 3J @G6CDE2E: ? 8 9 @ HD: 4
камекс? 2? 6>2: =[ wF>2?2 DA@<6DA6CD@? y29?2 {:?5D2J\y@?6D 42==65 E96 r|$ 2F5:E 7:?5:?8D “AC6=:>:?2CJ” 2?5 ?@E65 E96J H6C6 32D65 @? 2 D2>A=:?8 @7 J62CD\@=5 4=2:>D]к^ам
kAm“(9:=6H64@?E:?F6 E@92G6DF3DE2?E:G64@?46C?DH:E99@Hr|$2F5:ED2C64@?5F4E65[ wF>2?2 C6>2:?D 4@>>:EE65 E@ H@C<:?8 4=@D6=J H:E9 C68F=2E@CD E@ :>AC@G6 E96 |65:42C6 p5G2?E286 AC@8C2> 😕 H2JD E92E :?4C62D6 D6?:@CD’ 2446DD E@ 9:89\BF2=:EJ[ =@H6C 4@DE 42C6[” D96 HC@E6]к^ам
kAmq: == 😕 8 D9 @ H5 @ H? к^ам
kAm#6DF = ED @ 7 E96 h_2F5: ED[ E9@F89 J62CD @=5[ >:CC@C >@C6 C646?E 7:?5:?8D @7 2 D=6H @7 @E96C k2 9C67lQ9EEADi^^HHH]82@]8@G^AC@5F4ED^82@\`e\feQm8@G6C?>6? E C6A @ CEDk^2m2? 5 H9: DE = 63 = @ H6C = 2HDF: ED 2 == 68: ? 8 E92E | 65: 42C6 p5G2? E286 A = 2? DC @ FE:? 6 = J92G6:? 7 = 2E65 A2E:6? ЕК: D
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kAmpF5: E@CD 2C6 7:? 5:? 8 E96 D2>6:? 7 = 2E65 492C86D „@ G6C 2? 5 @ G6C 282:?[” 96 D2:5[ 255:?8i “x 5@?’E E9:?< E96C6 😀 6?@F89 @G6CD:89E]к^ам
kAm (96?: E4@>6D E@86EE: ?8>@?6J324 <7C @> E96962 = E9 A = 2? д[ 6IEC2A@=2E:@? 😀 E96 3:8 DE:4<:?8 A@:?E]к^ам
kAmp = E9 @ F89 6IEC2A @ = 2E: @? : DC @ FE:? 6 = J FD65 2D 2 E =:? >DE | 65: 42C6 2F5: изд[ r|$ @77:4:2=D 92G6 ?6G6C 2AA=:65 :E E@ |65:42C6 p5G2?E286 2F5:ED 3642FD6 @7 7:6C46 @AA@D:E:@? 7C@> E96 :?DFC2?46 :?5FDECJ]к^ам
kAm“(9:=6E9:D52E2:D>@C6 E92? 2 564256@=5[ >@C6 C646?E C6D62C49 56>@?DEC2E6D |65:42C6 p5G2?E286’D 277@C523:=:EJ 2?5 C6DA@?D:3=6 DE6H2C5D9:A @7 |65:42C6 5@==2CD[” D2:5 |2CJ q6E9 s@?29F6[ AC6D:56?E @7 E96 q6EE6C |65:42C6 p==:2?46[ 2 8C@FA E92E 25G@42E6D 7@C |65:42C6 p5G2?E286] $96 D2:5 E96:? 5FDECJ “56 =: G6CD 36EE6C 42C6 2? 5 36EE6C @ FE4 @ > 6D” 7 @ C A2E: 6? ED]k^Am
kAmqFE 4C:E:4D 2C8F6 E92E r | $2F5: ED @? = J2E:? J A6C46? E286 @ 7 | 65: 42C6 p5G2? E286 4 @? EC24ED? 2E: @? H: 56 2? 5 D9 @ F = 5 5 @> @ C6 E @ AC @ E64E E2I 5 @ == 2CD]K ^ Am
kAms =: EE = 6[ E96 7@C>6C r|$ @77:4:2=[ D2:5 E96 286?4J ?665D E@ “DE2CE <66A:?8 FA H:E9 E96 E:>6D 2?5 5@:?8 E96D6 2F5:ED @? 2? 2??F2= 32D:D 2?5 6IEC2A@=2E:?8 E96 C6DF=ED]к^ам
AAA: E.E[ 2 %6I2D 962=E9 42C6 2EE@C?6J[ BF6DE:@?65 E96 72:C?6DD @7 56>2?5:?8 9F86 C67F?5D 7C@> :?DFC6CD D@ >2?J J62CD =2E6C] %96 962 = E9 A = 2?D 2C6 8 @ :?8 E @ 7: 89E EE9 2?5?2: = 2?5?E > 2 < 6 E9: D 62DJ 7 @ C p | $[” D96 D2:5]к^ам
Am ——— k ^ am
kAmW k2 9C67lQ9EEADi ^^ <9؟]@ C8 ^ 23 @ FE \ FDQmzw} k ^ 2m Wz2: D6C w62 = E9} 6HDX: D 2؟ 2E: @؟ 2 =؟ 6HDC> E92E AC @ 5F46D:? \ 56AE9;FC? 2 =: D > 23 @ FE962 = E9: DDF6D]% @ 86E96C H: E9! @ =: 4J p? 2 = JD: D 2? 5! @ ==:? 8[ zw} 😀 @?6 @7 E96 E9C66 >2;@C @A6C2E:?8 AC@8C2>D 2E k2 9C67lQ9EEADi^^HHH]<77]@ C8 ^ 23 @ FE \ FD ^ Qmzuuk ^ 2m Wz2: D6C u2>: = J u @ F? 52E: @? X]zuu: D2? 6? 5 @ H65? @? AC @ 7: E @ C82?: K2E: @? AC@G:5:? 8:? 7 @ C > 2E: @? @? 962 = E9: DDF6D E @ E96? 2E: @?]Xk^Am
k9C^m
kAm©a_aa z2: D6C w62 = E9} 6HD]’: D: E k2 9C67lQ9EEADi ^^ HHH]<9?]@C8Qm <9?]@C8]k^2m s: DEC: 3FE65 3J%C: 3F? 6 сутринта @? E6? E p86? 4J[ {{r]к^ам

„Награден фанат на поп културата. Неизлечим почитател на пътуванията. Отдаден музикант. Биру гуру.“

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