Hundreds of Billions Are Not at Risk Because of Medicare Advantage Risk Scoring?

An odd left-wing group with the Orwellian title, Center for Integrity, has been on a crusade the last few months to expose the graft-ridden, corrupt risk adjustment scheme within the public Part C Medicare Advantage program (which applies to all Medicare Part C plans, not just Advantage plans, as well as to Obamacare¹-insurance plans). Rightlfully, no one in the press seems to care... at least until now. As of August 21, The Columbia Journalism Review posted the first article I've seen on the months-old expose... on an a website almost as obscure as mine.

The writer of this first article of many I'm sure is amazed that so little attention has been paid to the breathless Center of Integrity articles. Supposedly according to the Center of Integrity "Despite its broad implications for Medicare spending, the study by HHS... has attracted scant notice in Washington." 

Maybe the scant attention is because the "HHS study" is not a study--see image above. Read the HHS document (available on cms.gov) and you find that it is really kind of a white paper in an internal CMS newsletter written on such a trivial subject that no one at HHS or anywhere else except the Center for Integrity wants to make it into a study. And the white paper actually says: 

"Medicare has taken significant steps to mitigate the effects of (risk-score) coding intensity (that began in 2008) in (public Part C Medicare Advantage) MA, including implementing a 3.4% coding intensity adjustment in 2010 and revising the risk adjustment model (again) in 2013 and (again in) 2014. Given the continuous relative increase in the average MA risk score, further policy changes will likely be necessary." 

The white paper also notes Medicare 

"...is also recovering over payments identified by risk adjustment data validation (RADV) audits of selected MA contracts."

So this whole non-issue story² apparently dreamed up by Columbia is about a trivial policy begun in 2008, that didn't seem to be working so the rules were changed in 2010, 2013 and 2014, and the government is getting any money it overpaid back... if such overpayments are discovered (about which there is some doubt).

I guess that's why no one is paying attention. The GAO has said³ less than 1% of public Part C Medicare Advantage program spending is involved and can be clawed back.... IF it is in fact being paid improperly. That's not the hundreds of billions claimed by the Center of Integrity and Columbia... it's less than $2 billion (not that $2 billion isn't real money but on the scale of Medicare fraud and waste it's way down the list).

¹This blog refers to the Patient Protection and Affordable Care Act of 2010 as amended when referring to United States law and to Obamacare or Obamacare insurance when referring to the insurance enabled or mandated by the law.

²I have tried for about a month to get the CMS/HHS authors of the white paper noted in the image -- Welch and Kronick -- to answer some questions about their white paper. Apparently they think their own white paper is trivial but if they ever answer me, I will post their responses to open questions.

³According to the 2013 MedPAC Annual Report to Congress in the section on Medicare Advantage