News: New bill “No UPCODE Act” eliminates incentives for Medicare Advantage to overcharge

Recently, two U.S. Senators introduced the No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act, or “No UPCODE Act,” amidst recent outrage at Medicare Advantage (MA) plans receiving billions of dollars in overpayments. This follows CMS releasing its Medicare Advantage Risk Adjustment Data Validation final rule to get back some of those overpayments from audit findings, though only beginning with the payment year 2018, HealthLeaders reported.

“Federal audits have found that taxpayers have been overpaying bad actors running Medicare Advantage plans by billions of dollars every year, threatening the stability of both Medicare Advantage and traditional Medicare,” said Senator Jeff Merkley (D-Ore.), in a statement. “This fraud has to end.”

The No UPCODE Act will fight against fraud and upcoding through the following methods:

• Switching to a risk-adjustment model that uses two years of diagnostic data instead of just one
• Restricting the use of old or unrelated medical conditions to determine cost of care
• Ensuring Medicare is only charged for relevant treatment
• Closing the gap between how patients are assessed under MA and traditional Medicare

“Medicare is going insolvent in four years,” said Bill Cassidy (R-La.), the other senator introducing the bill. “The challenge is preserving that which is good while squeezing out waste. This bill is a step in that direction.”

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To look at the No UPCODE Act proposed, click here.