📢 Action Needed: Tell Congress to Protect Federal Funding
Federal Agency Releases Health Care Consolidation Report
Three federal agencies have released a report on health care consolidation and private equity that explores public responses and data on this topic. This report comes as a follow-up to a request for information (RFI) on health care consolidation that sought to gather information on “enforcement priorities and future action, including new regulations, aimed at promoting and protecting competition in health care markets and ensuring appropriate access to quality, affordable health care items and services” with a focus on private equity’s role.
Report Highlights Increased Costs and Other Consolidation Issues
The report sums up much of the public feedback included in the RFI about what people are experiencing and observing due to consolidation: increasing prices, harms to the quality of care, a lack of transparency system-wide, and the more private insurers—like Medicare Advantage (MA) plans—acquiring providers and suppliers, further collapsing the market.
Medicare Rights Cautions Against Drivers of Plan Overpayments
Plans get paid more for each enrollee even when they do not provide any care related to those diagnoses.
As Medicare Rights outlined in our comments on the RFI, we have grave concerns that consolidation in the health care market is driving up costs for beneficiaries, especially when MA plans can use subsidiaries to do health risk assessments or to comb through medical charts to “find” that their enrollees have diagnoses that make them look sicker than they really are. With these increased diagnoses, plans get paid more for each enrollee even when they do not provide any care related to those diagnoses. This is one driver of plan overpayment that must be curbed to bolster the sustainability of Medicare and protect beneficiary and taxpayer dollars.
Medicare Rights’ Advocacy Continues Amid Administration Change
The RFI and subsequent report were projects of the Biden-Harris administration. It is unclear what steps the Trump administration will take on this issue, but we will continue to urge CMS to solve the problem, including by limiting private equity involvement in health care, providing transparency on ownership of these firms and of MA organizations, and curtailing MA overpayment.
Further Reading
Read the RFI and our comments.
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