Thread by @LaurenWeberHP

THREAD: Medicare Advantage is the health care Silicon Valley gold rush right now. Big tech is pouring BIG money into these plans. Little known fact though: Medicare Advantage plans overbill the government by nearly $10 BILLION a year.

npr.org/sections/healt…

As @FredSchulte and I reported last week, the government has had a hard time stopping that due to industry influence. And big money keeps pouring in.

npr.org/sections/healt…

Here in St. Louis, Silicon Valley force John Doerr invested with his brother into a company with a Medicare Advantage plan that’s now grown to be worth $1.64 billion — Essence Group Holdings Corp. It’s a health care darling in an area that prides itself on its emerging tech scene

But now, the company is the subject of an HHS audit that says it can’t substantiate dozens of charges for stroke and depressive disorder — essentially, that it charged for ailments patients did not have or had had previously. It's also the subject of a separate CMS audit.

There's also a whistleblower lawsuit that alleges a pattern of upcoding to pad profits. One doc quoted in the suit alleged: “All I have heard about since we signed on with Essence is about coding to get paid more. This is doing little to enhance these patients’ care.”

Essence has repaid what HHS said it was owed and denied wrongdoing in the whistleblower case. In a statement, they told us: "It is a program designed around capturing the health status of the member and not on capturing codes."

Next up: more national expansion through its tech arm, Lumeris, which recently partnered with Cerner for a “Maestro Advantage” offering.

My latest: npr.org/sections/healt…