Insurance Co.’s Game Medicare Bonus Structure

By tfbuser on March 28, 2018 | Listed under Medicare | Leave a comment |

In the Monday March 12th 2018 Wall Street Journal (WSJ) the paper reported on some large insurance companies taking advantage and gaming the system to maximize a bonus structure in the Medicare Advantage plan system.

Insurers Game Medicare System to Boost Federal Bonus Payments (wsj 03/12/2018)

WSJ_Insures_game_Medicare_Bonus_2018_03_12  (right click to open pdf copy)

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Prominent health-care insurers are using a tactic known as crosswalking to collect millions of dollars in additional revenue from the federal government. The maneuver involves merging a patient’s original health-care plan with one ranked higher by Medicare—which uses a five-star scale—that gives financial bonuses to providers. The shift boosts a plan’s rating without requiring any actual improvement in quality. A Journal analysis showed that large managed-care companies such as Humana, UnitedHealth, Aetna and Anthem engage in the practice—including for around 1.45 million people for 2018 alone. For Humana, the shift is estimated to be worth nearly $600 million this year, according to some analysts. Although the two-year budget deal signed into law last month included a provision expected to significantly reduce the practice, Industry experts say insurers will still be able to achieve some gains on quality scores—and bonuses—from crosswalking.

Above is from – WSJ 10 point summary  2018/03/12 (thank you Mr Baker ) (twitter _Gerard Baker )


wsj_front_page_2018_03_12  (right click to open pdf)

WSJ videos on “Medicare”

WSJ print on “Medicare”

Insurers Game Medicare System to Boost Fed Bonus Payments 03/11/2018 

Cigna Deal Shows Being a Health Insurer Isn’t Enough Anymore – WSJ 03/08/2018.

Cigna Deal Shows Being a Health Insurer Isn’t Enough Anymore – WSJ_2018_03_08  (right click to eopen pdf)

Google – “Cross waking Medicare”

Medicare – CMS – via YouTube 

Good Info on Understanding Medicare  (2015 cms)


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