A new report from the Center for Economic and Policy Research, “Profiting at the Expense of Seniors: The Financialization of Home Health Care,” finds that new policies at the Centers for Medicare and Medicaid Services (CMS), which administers Medicare, let private equity and other corporate players profit wildly from owning home health care agencies. At the same time, these corporate players shortchange people with Medicare, keeping them from getting medically necessary home care that Medicare covers.
Unlike in days of yore when home care agencies were often mom and pop shops and nonprofit agencies, today private equity firms and health insurance companies often own home health care agencies. And, their incentive is to stint on care. The less care they cover, the more they profit. So, they override your treating physician regarding the care you need. They tend to think you don’t need care or need less care.
CMS says it wants to crack down on fraud. But, in many ways, it is encourage it, allowing health insurance companies and private equity firms to direct care and not overseeing these profit-maximizing entities or holding them accountable for their bad acts.
The fraud and bad acts go beyond home health care; it is pervasive in Medicare Advantage. The CMS Medicare Advantage payment system is defective, allowing corporate insurers who run Medicare Advantage plans to charge the government way more for their services than is appropriate. By CEPR’s calculations, based on various Medicare Payment Advisory Commission (MedPac) studies, Medicare Advantage plans receive about 19 percent more for each enrollee than CMS spends on people in traditional Medicare.
Corporate insurance company overcharges drive up Medicare Part B premiums for everyone with Medicare. As a result, people in Original Medicare are helping to subsidize the corporate health insurers running Medicare Advantage. Everyone, including taxpayers, are paying more for Medicare than they should be paying.
“Medicare services are almost entirely funded by the payroll taxes of working people. They deserve a health care system in their older years that is patient-centered, not profit-driven,” said Eileen Appelbaum, one of the authors of the report. “The goal of CMS is to change Medicare as we know it by 2030, and Congress must rise to the occasion to protect patients and taxpayers.”
Among other things, the report’s authors recommend that Congress strengthen Traditional Medicare. CMS also must oversee the insurance companies and private equity firms operating home health agencies and hold them accountable for their bad acts.
Here’s more from Just Care:
- Need home health care? Don’t count on Medicare
- Private equity buying up specialists and driving up health care costs
- Data show Medicare Advantage covers less nursing, rehab, home health care
- The choice between traditional Medicare and Medicare Advantage: It’s a sham
- Be a Hero tells Congress to end Medicare Advantage wrongful delays and denials of care
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