Quote:
Originally Posted by skyking
???? 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.
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Maybe I don't have any idea how Advantage plans work. I did a search on Medicare Advantage fraud it directed me to the CMS.gov website, it shows that each point I made is given as an example of fraud.