Posted on Sep 14, 2021
Data Mining Helped Medicare Advantage Plans Commit Fraud, Justice Department Alleges
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Responses: 1
PO1 William "Chip" Nagel
..."Medicare Advantage plans are paid more for "sicker" patients
The Centers for Medicare & Medicaid Services, or CMS, pays the health plans using a complex formula called a "risk score," which is intended to render higher rates for sicker patients and less for those in good health. The data mining company combed electronic medical records to identify missed diagnoses — pocketing up to 20% of new revenue it generated for the health plan."...
..."Medicare Advantage plans are paid more for "sicker" patients
The Centers for Medicare & Medicaid Services, or CMS, pays the health plans using a complex formula called a "risk score," which is intended to render higher rates for sicker patients and less for those in good health. The data mining company combed electronic medical records to identify missed diagnoses — pocketing up to 20% of new revenue it generated for the health plan."...
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