Central Louisiana News

U.S. Senator Bill Cassidy, M.D. (R-LA) has emphasized the importance of addressing Medicare overpayments during a confirmation hearing for Mehmet Oz, the nominee for Director of the U.S. Centers for Medicare and Medicaid Services (CMS). The discussion took place before the U.S. Senate Finance Committee.

Dr. Oz concurred with Senator Cassidy on the need to prevent Medicare Advantage plans from receiving inflated reimbursements when patients have multiple conditions that are not necessarily related to their care.

Senator Cassidy posed a question about evaluating Medicare Advantage in light of concerns regarding the potential insolvency of the Medicare trust fund and expanding budget deficits: “[A]s we look at the [Medicare] trust fund going insolvent and our budget deficit expanding, is [Medicare Advantage] a place you would look? And if so, how would you look in terms of getting better value for the dollar?”

Dr. Oz responded by highlighting systemic issues such as upcoding: “I think there are ways for us to look for example at the upcoding that is going on that is happening systemically… to make sure people are being appropriately paid for taking care of sick patience, but not for patients who aren’t ill,” he said. He further stated, “We actually have to go after places and areas where we are not managing the American people’s money well… both of us, I think, agree there are opportunities to do that.”

Senator Cassidy mentioned his legislative proposal aimed at tackling this issue: “I have a bill—the No UPCODE Act—that actually achieves that. So, I think you are going to be confirmed, and we will discuss that with you at a later date.”

In a previous Congress session, Senator Cassidy introduced his No UPCODE Act intending to refine how Medicare Advantage plans assess patient health risks and reduce overpayments while saving taxpayers billions by eliminating incentives for excessive charges.

Traditional Medicare reimburses providers based on treatment costs rendered; however, Medicare Advantage operates differently by paying a standard rate tied to an individual patient's health status. This system incentivizes making beneficiaries appear sicker than they might be in order to receive higher reimbursements.