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Parts of the Medicare Advantage program — essentially, private Medicare plan options — are ripe for reform, former and current top Medicare officials said Wednesday.

One of the most abused areas is risk coding, where health insurers document people’s illnesses and conditions as a way to get higher payments from the federal government, the officials said.


“We’ve literally created a nonproductive industry where there are businesses that collect diagnoses on Medicare Advantage solely for the purpose of getting paid — not to improve the care that these folks receive, but to improve the payment that the plans receive,” said Sean Cavanaugh, the top Medicare official at the Centers for Medicare & Medicaid Services during the Obama administration, during a Center for Medicare Advocacy conference Wednesday.

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