Fraud and Medicare Privatization

The NYT article published on October 8, 2022 joins the increasing number of investigative pieces that document fraud within the Medicare Advantage Program. This article publicizes the continued pervasive corruption of Medicare Advantage and the failure of Medicare’s administrators to control it, redesign its funding system, or shut it down. Instead, Medicare is rolling out the similarly funded and privatized ACO/REACH program. (ACO/REACH, more info here in a letter from Dr Susan Rogers, President of PNHP.)

Among other items in the article are these comments:

Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.


The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.

An earlier article, also in the New York Times discussed how Medicare Advantage enrollees are often denied needed care, here. And an article in COMMON DREAMS also discussed the NYT Medicare Advantage article.

The Center for Medicare Advocacy published an article that contains comments and links about a number of the recent articles that document the dramatic failings of the Medicare Advantage programs, here.

Privatizing Medicare has not resulted in financial savings for Medicare. On the contrary, corporations fraudulently siphon off billions of dollars, and audits show patients are denied care that is indicated. For-profit middlemen aren’t needed in healthcare, and Congress shouldn’t believe them when they tell us they are. End the privatization of Medicare.