Medicare Misfire: The $140 Billion Private Insurer Cash Grab

Imagine an amount large enough to eliminate Medicare Part B premiums or fully back Medicare’s prescription drug program. Now, let’s talk about the whooping $140 billion that private insurers are reportedly siphoning off via Medicare Advantage (MA) plans every year. Mind-blowing, right?

Physicians for a National Health Program (PNHP), an ardent supporter of a single-payer health insurance system, dove deep into the data. They found out that MA overcharges taxpayers by a staggering $88 billion annually as of 2022. And how is this done? Welcome to the world of “upcoding” where patients are made to seem way sicker than they truly are. The result? A fatter check from Uncle Sam.

Take it a step further, and the number could surge to an eyebrow-raising $140 billion. Why? Because people with better insurance are more likely to tap into healthcare services, a concept known as induced utilization.

According to PNHP’s findings, this isn’t just greed – it’s a systematic flaw. They describe it as a classic example of the insurance industry’s insatiable hunger for more, which ironically leaves patients high and dry when they need care the most.

To make matters worse, traditional Medicare doesn’t even cover essential benefits like dental, hearing, and vision. It’s no wonder that many patients opt for supplemental coverage or jump to an MA plan. If MA wasn’t hoarding these funds, the Medicare system could potentially be revamped to include these vital services.

But wait, there’s more. Since its inception in 2003, Medicare Advantage has swelled in size, thanks in part to taxpayer money. Even as the program faced criticism for everything from fraud to denying crucial care, a whopping 32 million people are now on MA plans.

Earlier this year, our current administration tried to put a leash on the MA overbilling beast, but heavy lobbying and a lot of noise from industry giants like UnitedHealth Group and Humana meant that the administration had to take a softer stance. And while all of this has been unfolding, top execs at major MA providers are pocketing fat paychecks. It’s like rubbing salt on an open wound.

Despite MA beneficiaries often being healthier (and less costly) than their traditional Medicare peers, they’re billed at the same rate. PNHP delves into why this might be happening. They suspect sicker patients may be dissuaded by the MA’s narrow care networks and other strategies that deny care. On the flip side, healthier individuals might be drawn to the zero-dollar premiums and the added perks like gym memberships.

Adding to the drama, a recent investigation showcased how MA plans to dominate the airwaves during open enrollment periods, often misleadingly so. All these sneaky tactics? Just so that they can fatten up their bottom lines.

Just a few days ago, Cigna, a major MA player, coughed up $172 million to settle allegations around false patient data submissions. Dr. Ed Weisbart of PNHP sheds light on the underlying issue – these overpayments are fueling profits without adding any real health value.

If seniors truly grasped that the chunk of change taken out of their Social Security is lining the pockets of Medicare Advantage moguls, pitchforks might just be in order. Many believe they’re paying premiums to back Medicare. The reality? Their hard-earned cash is being taken for a joyride by the MA industry.