On Oct. 24, the Office of Inspector General for the U.S. Department of Health and Human Services (HHS) released a report highlighting how Medicare Advantage (MA) plans have continued to exploit health risk assessments to inflate payments, costing taxpayers billions annually. The report reveals that many plans leverage questionable coding practices to artificially increase risk scores and receive higher reimbursements without necessarily improving patient care. These findings underscore the urgent need to pass the No UPCODE Act (S.1002), which would crack down on these abuses by increasing oversight, promoting transparency and ensuring that MA payments are based on accurate, clinically supported diagnoses. By addressing these systemic issues, Congress can protect the integrity of Medicare funds and ensure that payments are used to deliver meaningful care to seniors.
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