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Inquiring Taxpayers Want to Know Important Data on Medicare Advantage Spending

Francis Bacon's proclamation that "knowledge is power" is often quoted. Key information regarding Medicare Advantage expenditures is now available to researchers interested in the allocation of federal funds for this insurance coverage.

The Centers for Medicare and Medicaid Services ("CMS") has, for the first time, released to the research community important data regarding payments for senior citizens' healthcare. CMS has collected data regarding patient conditions and services received from 2012 to present, which is used to assist in its calculation of payments to Medicare Advantage insurers. 

CMS has released preliminary data from 2015. Researchers will be required to sign a data use agreement with the Research Data Assistance Center to gain access to the 2015 data. Seema Verma, a CMS Administrator, addressing an audience at the 2018 Datapalooza, stated that the Medicare Advantage, while not perfect is "adequate enough to support research." According to Ms. Verma, this data "...has the potential to help produce better, more targeted treatments" for Medicare Advantage patients, "... improving their quality of life while at the same time reducing costs."

CMS anticipates the release of additional data from insurers in late summer and after that CMS will issue final data reports. Thereafter, CMS plans to release data on Medicare Advantage enrollees annually.

Additionally, CMS anticipates it will make data regarding Medicaid and Children's Health Insurance Program ("CHIP") available. This will allow researchers access to data on pertaining to 70 million insured through Medicaid and CHIP.

On February 21,2018, in the Journal of the American Medical Association ("JAMA") published an article by Charles Ornstein, Niall Brennan and Austin Frakt addressing the need for researchers to access this data, noting that taxpayers are entitled to know how the government spends tax dollars for these benefits.

According to an article in modernhealthcare.com, the enrollment in Medicare Advantage has increased from "13% of the Medicare population, or 5.3 million individuals, in 2004 to almost 33%, or 19 million individuals, in 2017." In addition, the federal government's payments to Medicare Advantage plans "have increased from $77 billion to more than $200 billion per year over the same period, according to researchers." Id.

Certainly, with the substantial increase in government payments made to Medicare Advantage plans it is vitally important that we gain insight regarding how this money is being spent to ensure that fraud and abuse are kept at bay. 

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