Medicare Advantage health plans dodged auditors, overcharged taxpayers millions

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people. But federal officials rarely demand documentation to verify that patients have these conditions — or that they are as serious as claimed. (Getty Images)

In April 2016, government auditors asked a Blue Cross Medicare Advantage health plan in Minnesota to turn over medical records of patients treated by a podiatry practice whose owner had been indicted for fraud.

Medicare had paid the Blue Cross plan more than $20,000 to cover the care of 11 patients seen in 2011 by Aggeus Healthcare, a chain of podiatry clinics that was owned by Dr. Yev Gray, a Chicago podiatrist.