Kyle J. Caswell
Documents & Publications
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Upcoding in Medicare Advantage Among Dual Medicare-Medicaid Enrollees
Medicare Advantage (MA) plans report relatively more diagnoses per enrollee compared with those for similar fee-for-service enrollees, resulting in greater capitation payments. This practice, known as “upcoding,” results in excess government spending. Dual Medicare-Medicaid enrollees have increasingly enrolled in MA plans, some of which are targeted to duals. That duals… |