Central Louisiana News

U.S. Senators Bill Cassidy and Jeff Merkley have introduced legislation aimed at addressing overpayments in the Medicare Advantage program. The proposed bill, named the No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act, seeks to reform how Medicare Advantage plans assess patient health risks and curb excessive payments for care.

Senator Cassidy highlighted the urgency of this initiative by stating, "Medicare is going insolvent, and our budget deficit is expanding. We need to stop overpaying where we can if we’re to preserve Medicare for Americans who rely on it." He emphasized that the act is a necessary step towards ensuring Medicare's sustainability.

Senator Merkley expressed concerns about fraudulent activities within both Medicare Advantage and traditional Medicare programs. He noted, "Fraud, waste, and abuse by bad actors are destroying the stability of both Medicare Advantage and traditional Medicare—this must end." According to Merkley, their bipartisan effort aims to address these issues by targeting loopholes that enable exploitation of the system.

Medicare Advantage plans currently receive payments based on individual patient health assessments rather than actual treatment costs. This creates an incentive for providers to portray patients as sicker than they are to obtain higher reimbursements. A report from the Congressional Budget Office suggests that tackling overcoding could result in savings of $124 billion over a decade.

Earlier in March, Senator Cassidy discussed the No UPCODE Act during a confirmation hearing for Mehmet Oz, nominee for Director of U.S. Centers for Medicare and Medicaid Services before the Senate Finance Committee.