AARP Endorses Cassidy Bill to Eliminate Waste, Fraud, and Abuse in Medicare Advantage Program

WASHINGTON - The American Association of Retired Persons (AARP) endorsed the No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act. The landmark legislation introduced earlier this year by U.S. Senators Bill Cassidy, M.D. (R-LA) and Jeff Merkley (D-OR) improves the way Medicare Advantage plans assess patients' health risks and reduce overpayments for care. Medicare Advantage is a program that millions of seniors rely on to deliver high-quality care.

"AARP believes that the No UPCODE Act is a commonsense solution that protects older Americans, strengthens oversight, and helps to ensure the long-term sustainability of Medicare," said Bill Sweeney, AARP's senior vice president for government affairs.

"This bill addresses a problem both Republicans and Democrats have labeled as waste, fraud, and abuse. AARP agrees the No UPCODE Act protects seniors by preserving benefits and eliminating waste," said Dr. Cassidy. "When companies upcode, taxpayers foot the bill and patients get nothing. That's wrong."

Traditional Medicare plans reimburse providers for the cost of treatments rendered, while Medicare Advantage is paid a standard rate based on the health of an individual patient. Because of this, Medicare Advantage plans have a financial incentive to make beneficiaries appear sicker than they may be to receive a higher Medicare reimbursement. This bill will save $200 billion to $270 billion over 10 years.

The No UPCODE Act would eliminate those incentives by:

• Developing a risk-adjustment model that uses two years of diagnostic data instead of just one year.
• Limiting the ability to use old or unrelated medical conditions when determining the cost of care.
• Ensuring Medicare is only charged for treatment related to relevant medical conditions.
• Closing the gap between how a patient is assessed under traditional Medicare and Medicare Advantage.

Background

Earlier this year, Cassidy discussed his No UPCODE Act during U.S. Centers for Medicare and Medicaid Services (CMS) Director nominee Mehmet Oz's confirmation hearing before the U.S. Senate Finance Committee.

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