Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2005

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Correspondence issued by the Government Accountability Office with an abstract that begins "Medicare Advantage (MA) organizations offer an alternative to the original Medicare fee-for-service (FFS) program. Payments to MA organizations are, in part, based on the revenue and expenditure projections MA organizations submit to the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--prior to the start of each contract year. Once Medicare payments are determined, they are not modified based on differences between actual and projected expenses. In February 2008, we reported that, on average, MA organizations projected they would spend approximately 87 percent of their 2007 ... continued below

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United States. Government Accountability Office. June 24, 2008.

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Description

Correspondence issued by the Government Accountability Office with an abstract that begins "Medicare Advantage (MA) organizations offer an alternative to the original Medicare fee-for-service (FFS) program. Payments to MA organizations are, in part, based on the revenue and expenditure projections MA organizations submit to the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--prior to the start of each contract year. Once Medicare payments are determined, they are not modified based on differences between actual and projected expenses. In February 2008, we reported that, on average, MA organizations projected they would spend approximately 87 percent of their 2007 revenue on medical expenses, 9 percent on non-medical expenses, and that the remaining 4 percent would go to profits. The accuracy of MA organizations' projections is important because, in addition to determining Medicare payments, these projections also affect the extent to which MA beneficiaries receive additional benefits not provided under FFS and the amounts beneficiaries pay in cost sharing and premiums. This report responds to a Congressional request for additional information on the accuracy of MA organizations' projections. Specifically, this report focuses on how organizations' 2005 actual medical expenses, non-medical expenses, and profits compare to projections for the same year. A forthcoming report will provide a similar analysis of 2006 data."

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Government Accountability Office Reports

The U.S. Government Accountability Office (GAO) is an independent, nonpartisan agency that works for the U.S. Congress investigating how the federal government spends taxpayers' money. Its goal is to increase accountability and improve the performance of the federal government. The Government Accountability Office Reports Collection consists of over 13,000 documents on a variety of topics ranging from fiscal issues to international affairs.

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  • June 24, 2008

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  • June 12, 2014, 7:50 p.m.

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United States. Government Accountability Office. Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2005, text, June 24, 2008; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc298318/: accessed September 20, 2017), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.