According to the Ministry of Health and Human Services, it will begin to collect money from insurance companies when there is an investigation that they paid for tests that are not reflected in the patient’s medical records. The government has not sought refunds for those payments in more than a decade, the agency said.
“Today, we are taking long-term steps to move us in the direction of accountability,” HHS Secretary Xavier Becerra said Monday in a call with reporters. .
The sanctions are expected to set back $4.7 billion over the next decade, the agency said.
The disability payments are provided through Medicare Advantage, a health care program that nearly half of the 60 million people enrolled in Medicare are signed up for. Medicare Advantage is different from regular Medicare, with private companies offering plans that are reimbursed by the government for care. The government spent $900 billion last year on Medicare.
With the rise in popularity has come increased concern that insurers are ripping off taxpayers by exaggerating the patient’s illness to unlock higher reimbursements from the government. The HHS Office of the Inspector General raised red flags about $6.7 billion in patient charges that were not supported by medical records in 2017, for example.
Insurers are gearing up for a fight against the long-awaited final rule, and company leaders have raised concerns about the accuracy of the tests. The move will raise insurance costs, warned Matt Eyles, president of America’s Health Insurance Plans, the lobbying group for health insurance companies.
“Our position remains unchanged: This law is illegal and egregious, and should have been withdrawn rather than finalized,” Eyles said.