HHS ignored warning signs of Medicare payment waste, report says

The Obama administration reportedly ignored warning signs that was wasting billions of tax dollars because of a broken system used to pay for private Medicare plans.

At issue is the government’s formula that calculates how much to pay doctors for treating Medicare Advantage patients, which make up about one-third of all Medicare beneficiaries. Under the program, the federal government uses a formula known as a risk score — intended to measure the state of a patient’s health to calculate monthly payments to providers.

Critics have accused the government of using high risk scores that have cost billions of extra dollars. It now appears that the government had learned of that increased risk but failed to heed the warning, according to documents obtained by a Freedom of Information Request by the Center for Public Integrity.

The Centers for Medicare and Medicaid Services (CMS) created a report in 2008 that found risk scores had grown twice as fast as for other Medicare patients over four years — a trend that it described as “extremely unlikely.”

That study was never published, the newly released records show.

A CMS spokesman told the Center for Public Integrity that the agency intended to publish the findings, but “given competing workload demands we were not able to revise and resubmit the article.”