The Encounter Data Enhancement Act would require Medicare Advantage plans to report how much they are actually paying for patient services and how much patients are responsible for paying out of pocket.
In 2023, 54% of federal Medicare spending, or $454 billion, went to Medicare Advantage, according to a Nov. 15 press release from Dr. Cassidy’s office.
While the government already requires Medicare Advantage to report encounter data on services provided, the data is often incomplete and lacking key information, according to the release.
The Encounter Data Enhancement Act would help lawmakers conduct oversight of federal dollars going to Medicare Advantage plans, assess quality of care and strengthen healthcare access.
“For years, Medicare Advantage plans have been using a long list of tricks to overcharge the government for coverage, while delaying and denying care for seniors,” Ms. Warren said in the release. “By strengthening data transparency, this bipartisan bill will empower lawmakers and regulators to rein in this fraud and abuse and ensure taxpayer dollars are being used to deliver high-quality coverage for Medicare beneficiaries.”
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