People Who Want To Torpedo Medicare-For-All Are Endorsing... Status Quo Joe

A couple of weeks ago, Bernie enumerated a dozen or so prominent people who he would rather not get endorsements from. I don't think he really needed to worry about that. He was speaking about people who are likely already committed to either Status Quo Joe-- Pete when Biden self-destructs-- or Trump. I suppose there might be a couple of Kamala backers in the mix too. But no Bernie backers; no Warren backers. Basically, it was the "anybody but Bernie" crowd.

Yesterday, Mike Duggan, mayor of Detroit, endorsed Biden. He's Detroit's first white mayor in around 4 decades. Duggan made his millions when, as CEO of non-profit Detroit Medical Center, he sold it to all-about-profit Vanguard Health Systems. So I imagine he actually really knows how much help Medicare-For-All would be for his Detroit constituents. So why did he endorse Status Quo Joe?

Politicians who are endorsing Biden don't want to help anyone... but themselves. Am I saying that someone who endorses Biden deserves opprobrium and disdain? Unless today is the first time you've been over to DWT and have never heard me on Nicole Sandler's show or on David Feldman's show, you know that's just a rhetorical question. Of course, they deserve opprobrium and disdain-- and worse.

For example, these are the members of the Senate-- each of whom sporting an "F" grade from ProgressivePunch-- who have endorsed Biden so far (not counting former senators like slime ball Sickness Industry lobbyist Tom Daschle). All oppose Medicare-For-All and each has his or her net worth next to their name:

• Sen. Doug Jones (AL)- $12 million
• Sen. Dianne Feinstein (CA)- $79 million
• Sen. Tom Carper (DE)- $5.2 million
• Sen. Chris Coons (DE)- $8.8 million
• Sen. Bob Casey (PA)- $0.7 million

Last week Kaiser Health News reported that the system backed by Status Quo Joe, Mike Duggan, Tom Daschle Doug Jones, Dianne Feinstein, Tom Carper Chris Coons and Bob Casey-- and everyone else who endorses Biden-- has been bilking taxpayers for tens of billions of dollars. "Health insurers," they wrote, "that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone.

Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have.

Getting refunds from the health plans has proved daunting, however. Officials with the Centers for Medicare & Medicaid Services repeatedly have postponed, or backed off, efforts to crack down on billing abuses and mistakes by the increasingly popular Medicare Advantage health plans offered by private health insurers under contract with Medicare. Today, such plans treat over 22 million seniors, more than 1 in 3 people on Medicare.

Now CMS is trying again, proposing a series of enhanced audits tailored to claw back $1 billion in Medicare Advantage overpayments by 2020-- just a tenth of what it estimates the plans overcharge the government in a given year.

At the same time, the Department of Health and Human Services Inspector General’s Office has launched a separate nationwide round of Medicare Advantage audits.

As in past years, such scrutiny faces an onslaught of criticism from the insurance industry, which argues the CMS audits especially are technically unsound and unfair and could jeopardize medical services for seniors.
America’s Health Insurance Plans, an industry trade group, blasted the CMS audit design when details emerged last fall, calling it “fatally flawed.”

Insurer Cigna Corp. warned in a May financial filing: “If adopted in its current form, [the audits] could have a detrimental impact” on all Medicare Advantage plans and “affect the ability of plans to deliver high quality care.”
But former Sen. Claire McCaskill, a Missouri Democrat who now works as a political analyst, said officials must move past powerful lobbying efforts to hold health insurers accountable and demand refunds for “inappropriate” billings.

“There’s a lot of things that could cause Medicare to go broke. This would be one of the contributing factors,” she said. “Ten billion dollars a year is real money.”

Catching Overbilling With A Wider Net

In the overpayment dispute, health plans want CMS to scale back-- if not kill off-- an enhanced audit tool that, for the first time, could force insurers to cough up millions in improper payments they’ve received.

For over a decade, audits have been little more than an irritant to insurers because most plans go years without being chosen for review and often pay only a few hundred thousand dollars in refunds as a consequence. When auditors uncover errors in the medical records of patients they paid the companies to treat, CMS has simply required a rebate for those patients for just the year audited-- relatively small sums for plans with thousands of members.

The latest CMS proposal would raise those stakes enormously by extrapolating error rates found in a random sample of 200 patients to the plan’s full membership-- a technique expected to trigger many multimillion-dollar penalties. Though controversial, extrapolation is common in medical fraud investigations-- except for investigations into Medicare Advantage. Since 2007, the industry has successfully challenged the extrapolation method and, as a result, largely avoided accountability for pervasive billing errors.

“The public has a substantial interest in the recoupment of millions of dollars of public money improperly paid to health insurers,” CMS wrote in a Federal Register notice late last year announcing its renewed attempt at using extrapolation.

Penalties In Limbo

In a written response to questions posed by Kaiser Health News, CMS officials said the agency has already conducted 90 of those enhanced audits for payments made in 2011, 2012 and 2013-- and expects to collect $650 million in extrapolated penalties as a result.

Though that figure reflects only a minute percentage of actual losses to taxpayers from overpayments, it would be a huge escalation for CMS. Previous Medicare Advantage audits have recouped a total of about $14 million, far less than it cost to conduct them, federal records show.

Though CMS has disclosed the names of the health plans in the crossfire, it has not yet told them how much each owes, officials said. CMS declined to say when, or if, they would make the results public.

This year, CMS is starting audits for 2014 and 2015, 30 per year, targeting about 5% of the 600 plans annually.

This spring, CMS announced it would extend until the end of August the audit proposal’s public comment period, which was supposed to end in April. That could be a signal the agency might be looking more closely at industry objections.