Quote:
Originally Posted by Joeint
Have you considered fraud in advantage plans
Billing for services not rendered.
Altering medical records.
Use of unlicensed staff.
Drug diversion (e.g. dispensing controlled substances with no legitimate medical purpose)
Kickbacks and bribery.
Providing unnecessary services to members.
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???? You have no idea how Medicare Advantage works.
1. They are paid a monthly per Capita amount not per service billed.
2. The plans do not maintain medical records. The contracted providers do.
3. If the plans are paid a fixed amount (based on age and sex of the beneficiary) they have no incentive to "provide unnecessary services" or medications.
4. Plans are typically paid 95% or less of average cost per beneficiary in the county of residence.
There is so much over utilization in healthcare that they can provide free extra benefits by managing utilization and quality.