SUSAN M. COLLINS, MAINE CLAIRE MCCASKILL MISSOURI CHAIRMAN RANKING MEMBER ??nitrd ?aws $rnatr SPECIAL COMMITTEE ON AGING WASHINGTON, DC 20510?6400 (202) 224?5364 May 26, 2015 The Honorable Andrew Slavitt Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Washington, DC. 20201 Dear Administrator Slavitt, I am writing regarding reports of fraud and abuse related to privately run Medicare plans, also known as Medicare Advantage plans. In recent weeks, my of?ce has been made aware of allegations of billing abuse by Medicare Advantage plans that in?ate Medicare risk scores. Medicare Advantage plans, run through approved private insurance companies, offer an alternative to the traditional Medicare program for seniors. The Centers for Medicare Medicaid Services (CMS) pay these plans a set fee per month, per patient that is based on a formula known as a risk score. Risk scores measure the state of the bene?ciary?s health, and the fee that CMS pays the bene?ciary?s Medicare Advantage plan is set accordingly. Therefore, CMS pays higher fees to Medicare Advantage plans that cover sicker bene?ciaries than those that cover bene?ciaries in better health. There is evidence that Medicare Advantage plans have been in?ating risk scores in order to reap more money from the Medicare Trust Funds. Federal court records show that since 2010, there have been at least six whistleblower lawsuits alleging that Medicare Advantage plans in?ated risk scores.1 I ?nd this extremely troubling as over 15 million Americans, about 30% of the total Medicare population, are enrolled in Medicare Advantage plans and in Fiscal Year 2014 alone, the Government Accountability Of?ce reported that more than $12 billion in improper payments were made to Medicare Advantage plans?"3 With fraudulently in?ated risk scores potentially costing taxpayers billions of dollars every year and resulting in less money in the Medicare Trust Funds for our seniors, this is an issue that must be investigated further. As part of my ongoing work to ensure that Medicare bene?ciaries receive high quality health care and that taxpayer dollars are spent wisely, I therefore request a brie?ng for my staff 1 More Whistleblowers Say Health Plans Are Gauging Medicare, National Public Radio (April 23,2015) 2 Medicare Advantage Fact Sheet, Henry J. Kaiser Family Foundation (May 1, 2014) 3 Government Accountability Of?ce, Testimony before the Senate Committee on the Budget (March 4, 2015) (GAO-15-4410T) Web Site: about what CMS is doing to address the issue of inflated risk scores. I request that this brie?ng take place on or before June 12, 2015. Thank you for your attention to this important matter. Please contact Cathy Yu on the Aging Committee staff at (202) 224-7752 with any questions. Sincerely, Ranking Member ee: Susan Collins Chairman