Insurance Companies Must Not Take Shortcuts with Medicare Advantage Record Keeping


Medicare Advantage has allegedly overcharged Medicare by $1,000 per policyholder. Melanie Musson, an insurance expert with, says, “Medicare Advantage insurance providers must prepare to justify their charges by keeping accurate records and documentation.”

Medicare Advantage plans are increasing in popularity, but this private insurance alternative to government-run Original Medicare must be careful to be transparent or keep accurate records, or they’ll pay the price.

Kaiser Health News recently reported on a trend of Medicare Advantage providers dodging auditors and overcharging taxpayers through billing Medicare.

Medicare Advantage Audit Failures Are Nothing New

In 2011, Blue Cross of Minnesota couldn’t locate records of podiatry patients who were treated at a podiatry clinic accepting Medicare. Federal audits revealed a combined care cost that exceeded $20,000. Due to circumstances surrounding that case and the podiatry clinic facing fraud allegations, the insurance provider was granted a hardship exemption.

But as demands for transparency increase, these exemptions may be harder to obtain, making it vitally important for Medicare Advantage providers to keep their own records and not depend on healthcare providers to give them documentation if needed for an audit.

The Cost of Medicare Advantage Failures

Medicare Advantage plans charge policyholders a premium, and they work with Medicare for payment for Medicare-covered services. Federal audits revealed that Medicare Advantage plans had overcharged Medicare for services averaging $1,000 per Medicare Advantage policyholder.

That equates to millions of dollars overcharged to Medicare. Those costs are passed down to taxpayers.

Medicare Advantage Should Prepare for More Oversight

The federal government has been working to demand repayment for overcharges from Medicare Advantage plan providers. So, these providers must prepare to back up all their charges with the proper documentation to avoid additional repayments or penalties.

Car insurance providers proved their commitment to fair compensation by issuing auto insurance givebacks in the midst of COVID-19 shutdowns. Medicare Advantage providers should take note and prepare to pay back the federal government if necessary.

Whether or not Medicare Advantage actually overcharged Medicare and, thereby, American Taxpayers is a moot point. With proper documentation and record-keeping, insurance providers can prove the legitimacy of their charges.

Medicare Advantage providers must resist the urge to save money by cutting corners and must instead keep organized records and follow the governmental red tape associated with the medicare program.

By doing so, insurance providers can protect themselves and regain the trust of their policyholders and the American taxpayers.

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