DeParle: Managed care plans ‘gaming the system’
DeParle: Managed care plans gaming the system’
Based on a new study of alleged overpayments to hospitals owned by managed care companies, HCFA administrator Nancy-Ann DeParle has accused managed care plans of "gaming" the Medicare system. Deparle adds that the agency will step up its investigations in this area.
Department of Health and Human Services (HHS) Inspector General (IG) June Gibbs Brown delivered the report to DeParle May 16. It charges that between 1991 and 1996 Medicare overpaid hospitals at six managed care firms by more than $200 million for inpatient services furnished to beneficiaries who had disenrolled from managed care risk plans.
According to the IG, Medicare paid hospitals $224 million for these services instead of $20 million in capitation payments which these hospitals would have received had these beneficiaries not disenrolled.
According to DeParle, managed care plans may be attempting "to avert their own costs at a high cost to the Medicare program." She also agreed there was a problem with disenrollment "just prior to receiving expensive inpatient services" and concluded these findings "suggest the need for further investigations" and "careful monitoring of the managed care environment."
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