October 10, 2022

The New York Times had a blockbuster piece this weekend about massive Medicare Advantage fraud that everyone should read. (If you don't have a subscription, Common Dreams covers it here.)

The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.

Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Medicare Advantage is another one of those "running government like a business" solutions. The plans were supposed to bring cost-saving innovations and better health care to the marketplace. Ha, ha!

Well, we all know how that goes. The Times found that major insurers resorted to outright fraud to make billions of extra dollars. And thanks to relentless advertising, Medicare Advantage signups are now on track to overtake traditional Medicare.

If you are poor, I understand the attraction of Medicare Advantage. Free dental and vision! Gym memberships! Pickup and delivery to the doctors! Most important, no monthly premiums! But as we learned in the times before Obamacare, private insurers are only looking to fatten the bottom line.

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Now, here's an interesting aside. Mehmet Oz is reported to own $550,000 in UnitedHealth Group stock -- the largest seller of Medicare Advantage plans. Guess what he's pushing?

By contrast, Oz bills his own health care plan as “Medicare Advantage for All.” Such a program could move seniors and most Americans into private insurance plans that have been raising premiums and denying roughly one in ten medical claims, according to a recent government report finding that the plans frequently refuse to cover services required by Medicare.

To pay for his privatization plan, Oz has proposed a 20 percent payroll tax, which would ultimately transfer money from workers to the Republican Party’s private insurance donors that have been reporting record profits while jacking up premiums.

In other words, Oz himself wants to increase taxes on lower- and middle-class Americans to fund his own version of a corporate-run, universal health care system — one that could come with high patient costs, continued barriers to care, and a windfall for the health insurance industry.

And look at this. People on Medicare Advantage disenroll later in life because they realize how thoroughly screwed they are:

The OIG report came on the heels of another important study by the Government Accountability Office, which found that many Medicare Advantage beneficiaries try to get out of their private plans late in life because of coverage denials and inadequate provider networks (especially rehab and skilled nursing facilities). This is from the GAO report:

We found that Medicare Advantage beneficiaries in the last year of life disproportionately disenrolled to enroll in (original Medicare) fee-for-service, indicating possible issues with their care. Shifting end-of-life costs to fee-for-service increased Medicare spending by hundreds of millions of dollars.

That’s right. We’re talking about hundreds of millions of dollars that private Medicare Advantage plans won’t have to pay but that taxpayers have to pick up. That enables private insurers to avoid paying for an untold number of claims–and that makes Wall Street very happy.

So now we know: Mehmet Oz is running for the Senate as an insurance company shill. Tell your friends.

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