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Private Medicare insurers got about $4.2 billion in extra federal payments in 2023 for diagnoses from home visits the companies initiated, even though they led to no treatment, a new inspector general’s report says. The extra payments were triggered by diagnoses documented based on the visits, including potentially inaccurate ones, for which patients received no other medical services, the report says. Insurers offering private plans under Medicare, known as Medicare Advantage, are paid more when patients have costly conditions. (Weaver and Mathews, 10/24)

For the past six months, the CBS News Texas I-Team has spoken with more than a dozen Medicare recipients who reported fraudulent activity on their accounts. According to a federal government report, an estimated $60 billion is lost annually to Medicare fraud. Earlier this year, Medicare suspended the accounts of 11 medical suppliers suspected of fraudulently billing the government for nearly $3 billion worth of urinary catheters. One of these companies listed its headquarters at an office in Grand Prairie, but by the time their account was suspended, those in charge had long disappeared. (New, 10/23)

Medicare marketers expect shifts in the Medicare Advantage market to prove lucrative as beneficiaries react to changing benefits and less competition in certain regions, even though insurers such as Centene and Aetna have cut back on commissions. “We haven't seen this much disruption in years, where you have a lot of consumers who need to shop and likely need to make switches,” GoHealth CEO Vijay Kotte said. “We’re feeling pretty good.” The Medicare annual enrollment period began Oct. 15 and ends Dec. 7. (Tepper, 10/23)

In the midst of open enrollment, there’s a lot of consumer (and investor) focus on Medicare Advantage STAR ratings that were announced earlier this month. STAR Ratings seem simple enough on the surface. Plans are rated by the Centers of Medicare and Medicaid Services (CMS) on a scale of 1 (low) to 5 (high) based on a basket of measures that capture a Medicare Advantage health plan’s clinical performance and member experience. (Jain, 10/24)

Allina Health has notified thousands of patients with Humana Medicare Advantage plans that their doctors might be out-of-network next year and therefore only available with higher out-of-pocket costs unless the Kentucky-based insurer agrees to a contract that reduces claims denials and prior authorization rules. The Minneapolis-based health system, one of the largest operators of hospitals and clinics in Minnesota, alerted about 18,000 patients of the potential disruption last week, just as Medicare open enrollment was getting underway. (Snowbeck, 10/23)