POLITICO: Top House Democrat wants more from CMS on Medicare Advantage

House Democrats said the Biden administration must do more to rein in overpayments and increase transparency of Medicare Advantage plans.

Lawmakers spoke during a press conference Tuesday highlighting issues with care denials and quality in the popular Medicare Advantage program. Democratic lawmaker anger over the program has been simmering in recent months after reports of insurers using algorithms to deny Medicare claims that should have been approved.

Rep. Lloyd Doggett (D-Texas) called on the Centers for Medicare and Medicaid Services to take a closer look at how Medicare Advantage plans are marketed to seniors. Enrollment has surged past 30 million this year and the number of plans available for seniors to choose from has skyrocketed.

But Doggett said plans are not transparent enough with seniors about the downsides of Medicare Advantage, which can include narrow physician networks or cost containment tools that can lead to coverage getting denied.

“I do think it is really outrageous to be leading people to believe they will be getting free groceries and free rent,” he said after the event. “What are you giving up to get free groceries?”

Doggett was joined by Sen. Elizabeth Warren (D-Mass.), and Reps. Ro Khanna (D-Calif.), Rosa DeLauro (D-Conn.) Katie Porter (D-Calif.), Barbara Lee (D-Calif.), and Mark Pocan (D-Wis.).

Critics of Medicare Advantage plans are unlikely to pass legislation through a divided Congress where insurers have plenty of support in both parties. That has led some lawmakers to push the Biden administration on several issues.

“They delayed action on reducing the amount of overpayments to Medicare Advantage,” Doggett said. “They need to act more vigorously on that.”

Critics charge that some plans try to make patients appear sicker than they are to qualify for more payments from the federal government.

An analysis from the University of Southern California estimates such overpayments could exceed $75 billion a year.

CMS’ final Medicare Advantage rate notice rule released earlier this year will phase in changes to the risk adjustment payment model over three years starting in 2024. A proposed version would have installed the changes all at once in 2024.

CMS did not immediately return a request for comment.