医疗保险优势在欺诈的审查下;尽管存在问题,但计划增加250亿美元的付款. Medicare Advantage under scrutiny for fraud; $25 billion increase in payments planned despite issues.

医保优势是一项针对老年人的流行健康保险方案,它正面临对欺诈和错误编码的更多审查,以抬高报销率。 Medicare Advantage, a popular health insurance program for seniors, is facing increased scrutiny over fraud and improper coding to inflate reimbursement rates. 司法部和HHS OIG正在调查这些做法,其中包括夸大病人病情的严重性。 The DOJ and HHS OIG are investigating these practices, which involve exaggerating the severity of patients' conditions. 最近的立法努力,如《无UPCODE法》,旨在通过改变风险调整的计算方式来遏制这些做法。 Recent legislative efforts like the No UPCODE Act aim to curb these practices by changing how risk adjustment is calculated. 尽管存在这些问题,该方案继续增长,CMS宣布2026年的付款增加250亿美元。 Despite these issues, the program continues to grow, with CMS announcing a $25 billion increase in payments for 2026.