Medicare Halts Release of Much-Anticipated Data

By Charles Ornstein
ProPublica, June 29, 2017

In the past few years, many seniors and disabled people have eschewed traditional Medicare coverage to enroll in privately run health plans paid for by Medicare, which often come with lower out-of-pocket costs and some enhanced benefits.

These so-called Medicare Advantage plans now enroll more than a third of the 58 million beneficiaries in the Medicare program, a share that grows by the month.

But little is known about the care delivered to these people, from how many services they get to which doctors treat them to whether taxpayer money is being well-spent or misused.

The government has collected data on patients’ diagnoses and the services they receive since 2012 and began using it last year to help calculate payments to private insurers, which run the Medicare Advantage plans. But it has never made that data public.

Officials at the Centers for Medicare and Medicaid Services have been validating the accuracy of the data and, in recent months, were preparing to release it to researchers. Medicare already shares data on the 38 million patients in the traditional Medicare program, which the government runs.

The grand unveiling of the new data was scheduled to take place at the annual research meeting of AcademyHealth, a festival of health wonkery, which just concluded in New Orleans.

But at the last minute, the session was canceled.

In a statement, CMS said there were enough questions about the data’s accuracy that it should not be released for research use. CMS said it will examine the data for 2015 “to determine if it is robust enough to support research use.”

(Health economist Austin) Frakt notes that researchers know “vastly more” about traditional Medicare because the data has been available for decades. “The claim is that private insurers are innovating in ways that traditional program is not. We need to validate that. We need to know what they’re doing for the benefit of everyone. We can’t do that without the data.”

In recent years, private insurers that run Medicare Advantage plans have been under fire for allegedly overcharging Medicare. The Center for Public Integrity reported last year that more than three dozen audits had found that plans overstated the severity of enrollees’ medical conditions to garner more money. (The Center had to file a Freedom of Information lawsuit to access the audits.) In 2014, the Center’s reporting suggested that insurers had collected $70 billion in improper payments from 2008 to 2013.

The Department of Justice recently intervened in two federal lawsuits in Los Angeles (here and here) accusing UnitedHealth Group of providing “untruthful and inaccurate information about the health status of beneficiaries” to boost its revenues.

“The system used to capture encounter data has numerous unresolved operational and technical issues and fails to capture a reliable, comprehensive picture of beneficiaries’ diagnoses,” a spokeswoman for America’s Health Insurance Plans said in an email. “This could put payments at risk, which could also increase premiums and decrease benefits. We look forward to working with Administrator Verma and CMS to improve the encounter data and address these issues.”

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We have access to the data for the traditional Medicare program, but the same data have not been available for the private Medicare Advantage plans. We do know that the private plans have been cheating the taxpayers, initially by selectively marketing their products to less expensive, healthier populations while receiving full payments based on average needs, and then, later, by upcoding the diagnoses in order to receive unwarranted higher risk adjusted payments as if the beneficiaries were sicker than they actually are.

Now that CMS is headed by a pro-market ideologue – Seema Verma – the promised release of the data was reversed with the explanation that “there were enough questions about the data’s accuracy that it should not be released for research use.” Yet it is being used to overpay the private plans. Verma has stated repeatedly that the private plans produce higher quality at lower costs, yet she refuses to let us see the data. What data we do have suggest the opposite.

With the overpayments, the Medicare Advantage plans are able to offer their products with lower premiums and cost sharing, obviating the need for patients to purchase Medigap plans. With this perception of a better deal, enrollment in the private plans continues to increase, helping to fulfill the goal of privatizing Medicare. Once the private plans have supplanted much of the traditional Medicare program, the public privatizers plan to decrease the government contribution to the plans (decrease premium support – vouchers) leaving Medicare beneficiaries to pick up more and more of the costs.

Look, it’s our government, our taxes, our Medicare. Keeping us in the dark allows them to surreptitiously inflict their ideology upon us – an ideology that is shifting wealth upwards, away from workers. After listening to the Fourth of July speeches celebrating America, it does not seem that privatizing Medicare is the way we make America great again.

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