Much like urban legends, the recurring tales of Medicare Advantage (MA) plans being accused of manipulating diagnoses and denying care that otherwise would have been covered under traditional Medicare are gaining traction.

They are now even being referred to as Medicare “Dis-Advantage” plans because of all the manipulation, much related to the fact that a MA patient is more expensive to the Medicare program than a traditional Medicare patient. The government pays MA insurers a set amount for each person who enrolls, with higher rates for sicker patients.

But the Department of Justice (DOJ) recently uncovered irregularities in reporting accurate patient diagnoses, even accusing some insurers of developing elaborate systems to make their patients appear as sick as possible, often without providing additional treatment.

During the next live edition of Talk Ten Tuesdays, nationally recognized healthcare consultant Terry Fletcher will report on the details.

Other segments during the live broadcast will include the following:

• PSI Series:  The series on patient safety indicators (PSIs) continues with Dr. Jennifer Brettler and Kimberly Seery reporting on the PSI Inclusion and Exclusion criteria for PSI 04.
• Talk Law: Karen George, an attorney at Buchalter in Los Angeles, and a member of the firm’s health care practice group, will file a report on the latest healthcare laws.
• News Desk: Timothy Powell, CPA will anchor the Talk Ten Tuesdays News Desk.
• TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.