With Medicare Advantage (MA) plan payment rates and business practices increasingly drawing attention in Congress, a group of seven Senate Democrats and Vermont Independent Sen. Bernie Sanders have written to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz to “urge you [Oz] to hold insurance companies accountable for persistent abuses in the MA program.”

The lawmakers said, “this work takes on greater urgency in light of troubling comments from Medicare Director Chris Klomp that the administration may be exploring options to automatically enroll seniors and people with disabilities into MA, subjecting enrollees to more frequent care denials and higher out-of-pocket costs, while likely costing taxpayers billions of dollars.”

Media reports said Klomp told an industry conference that the agency is "mulling the feasibility" and "thinking through" whether the current system delivers the best long-term outcomes. The official questioned whether traditional fee-for-service Medicare creates a consistent relationship between patients and providers and asked whether models built around MA or accountable care organizations could produce "healthier beneficiaries."

Just on Monday, CMS released its Calendar Year 2027 MA and Part D Rate Announcement, projecting a 2.48 percent or $13 billion rise in MA payments to plans in 2027, which dwarfs the January proposed MA rate increase of only 0.09 percent or $700 million.

Back to the letter. The senators said aside from the numerous financial problems and patient care concerns the Klomp proposal raises, “it also very likely violates the requirements for any CMS Innovation Center models to reduce taxpayer spending. We instead urge you to focus on reining in abuses by MA insurers.”

Fraud and Abuse Questions

The senators said while the Trump Administration has made rooting out fraud, waste, and abuse a priority in the Medicaid program, for example, while “legitimate fraud, waste, and abuse in MA remains largely unchecked.”

The actions requested by the lawmakers include:

1. Further reducing overpayments from risk adjustment and favorable selection;

2. Preventing insurance companies from denying medically necessary services; and

3. Holding MA insurers accountable for engaging in anti-competitive behavior and evading regulatory protections

Senators signing the letter include Sanders, Elizabeth Warren (D-Mass.), Richard Blumenthal (D-Ct.), Cory Booker (D-N.J.), Richard Durbin (D-Ill..), Edward Markey (D-Mass.), Jeff Merkley (D-Ore.), and Tina Smith (D-Minn.).

Read the letter here.

Comments? Contact Patrick Connole at pconnole@parkplacelive.com.