The CMS delayed release of Medicare Advantage data from 2014 that it planned to make public at the AcademyHealth’s annual research meeting last week, ProPublica reported.
CMS said there were questions about the data’s accuracy so the agency decided it shouldn't release the data to researchers. The agency said it would examine the 2015 data to decide whether to release that information. Medicare already provides data on the 38 million traditional Medicare beneficiaries.
- In response to the delay, Niall Brennan, former chief data officer of CMS, who worked on the data, said he was disappointed with CMS' decision. He tweeted, “[h]ope CMS not backsliding on #opendata.”
Researchers eagerly awaited the data release to finally get to dig into the Medicare Advantage numbers. As Medicare Advantage has gained popularity, there has been added scrutiny — especially regarding payments.
Brennan acknowledged in a tweet that the MA data “had some quirks,” but he wondered why the data is used for payments to insurance companies, but isn’t good enough for researchers.
One-third of all Medicare beneficiaries, about 19 million people, are enrolled in MA plans. Congress created the program to have private payers help cover an often costly patient population. Congress added a risk adjustment payment program in 2003 that pays insurers more for sicker beneficiaries, but that program has also led to claims of overpayments to payers.
The Department of Justice recently became involved in two high-profile False Claims Act cases against UnitedHealth after charges of overpayment to the payer, which is the largest MA insurer. The Justice Department is also investigating other payers involved in Medicare Advantage.
How much has CMS overpaid payers in Medicare Advantage? The CMS last year estimated it overpaid MA organizations $14.1 billion in 2013. MA payers received about $160 billion in 2014 for about 16 million beneficiaries. The CMS estimated about 9.5% of those payments were improper.
In January, the Government Accountability Office spoke out about the accuracy of Medicare Advantage data, which is used to decide payments to health insurance companies.
Congress is also interested in the overpayment issue. Sen. Chuck Grassley (R-IA), chairman of the Senate Judiciary Committee, sent a letter to CMS Administrator Seema Verma in April questioning what CMS is doing to “implement safeguards to reduce score fraud, waste and abuse.”
Getting data from CMS could have allowed researchers to dig into that kind of information, but for now researchers and industry watchdogs will have to wait.