Medicare Advantage Is Scamming You

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Perhaps that’s because, as the Journal’s investigations found, Medicare Advantage insurers routinely pad their government reimbursement requests with spurious diagnoses. For example, an astounding 66,000 Medicare Advantage patients were diagnosed with diabetic cataracts even after these patients had surgery to correct them, making that diagnosis, in the Journal’s words, “anatomically impossible.” In other instances, patients whom Medicare Advantage insurers reported as HIV positive received none of the recommended treatments. If a doctor failed to furnish a desired diagnosis, insurers dispatched a nurse to the patient’s home to find one. Medicare Advantage insurers also conned veterans into enrolling in the program even though they were already covered adequately by the Veterans Administration health system, which has repeatedly been demonstrated to be superior to private hospital care (something else the public is reluctant to believe).

UnitedHealth, the parent company of United Healthcare, whose chief executive Brian Thompson was assassinated last month, is, according to the Journal, a particular offender, furnishing doctors with checklists of possible diagnoses. Looking at Medicare data between 2019 and 2022, the Journal found that patients who moved from traditional Medicare to UnitedHealth’s Medicare Advantage plans “got 55 percent sicker, on paper” during their first year in Medicare Advantage. (UnitedHealth replied in a written statement that it provided “more accurate diagnoses” and alleged, without providing evidence, that the Journal’s reporting method was flawed.)

So, OK, Medicare Advantage charges the federal government more. Don’t I want, as a patient, more money to be lavished on my health care? The sickest customers do not. People in their final years of life left Medicare Advantage for traditional Medicare “at double the rate of other enrollees” between 2016 and 2022, the Journal reported in November. This exodus of expensively dying patients saved Medicare Advantage $10 billion during this period.



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