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Medicare Advantage Fraud Reported by Top Insurers

A recently released analysis by The New York Times has revealed that most of the major insurers involved with Medicare Advantage have been found to have committed fraud due to their involvement in the program. There are serious questions about whether the program can reduce costs and provide services more efficiently than the traditional Medicare program under these circumstances.

There has been an investigation by the federal government found eight of the top ten Medicare Advantage insurers (representing more than two-thirds of the market) have submitted inflated bills, according to Margot SangerKatz and Times Reed Abelson. Several lawsuits have been filed against four of the five largest players, UnitedHealth, Humana, and Elevance (formerly Anthem), alleging that the companies attempted to misdiagnose patients.

I find it ironic that Medicare Advantage allows private insurers to manage federally funded healthcare plans for people aged 65 and older. To reduce costs, this program was designed. Evidence suggests that insurance companies have taken advantage of Medicare Advantage to increase their profits. Their techniques include making the patient appear sicker than they are to inflate their medical bills as much as possible.

Abelson and SangerKatz have documented that a program designed to reduce healthcare spending is substantially more expensive than the traditional government healthcare program.

In terms of amount, it is quite a considerable sum. In some cases, it is now more expensive for Medicare Advantage than the Army and Navy, according to Abelson and SangerKatz. As a result of the system’s overpayments, it is estimated that the overpayments will amount to between $12 billion and $25 billion, which is more than the federal government spends on the Environmental Protection Agency and the FBI combined.

There is also uncertainty as to whether Medicare Advantage insurers do a better job of delivering health care even though the program is growing rapidly and will soon account for most Medicare beneficiaries. An expert in the healthcare field, Merrill Goozner, has said that studies show no difference in patient satisfaction and outcomes compared to Medicare fee-for-service.

There is a huge profit to be made from this business. However, there is one thing that can be said with certainty. There is no doubt that Medicare Advantage is one of the most lucrative businesses within the health insurance industry, according to Goozner.

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