Medicare cuts I could support
I’m on traditional Medicare and so is my wife. We’ve been happy with the coverage.
We both elected not to get Medicare Advantage plans. Not only because we’d read about a higher rate of denial of care for MA plans, but because of the overcharging. If DOGE really wanted to go after a soft target, it would be MA plans. Of course, they won’t, because private enterprise.
Imagine my surprise, then, when I read that the Trump DOJ was going after health insurance companies for corruption:
“The United States filed a complaint today under the False Claims Act (FCA) against three of the nation’s largest health insurance companies — Aetna Inc. and affiliates, Elevance Health Inc. (formerly known as Anthem), and Humana Inc. — and three large insurance broker organizations — eHealth, Inc. and an affiliate, GoHealth, Inc., and SelectQuote Inc. The United States alleges that from 2016 through at least 2021, the defendant insurers paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers’ Medicare Advantage plans.
“Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries may choose to enroll in health care plans (MA plans) offered by private insurance companies, such as defendants Aetna, Anthem, and Humana. Many Medicare beneficiaries rely on insurance brokers to help them choose an MA plan that best meets their individual needs. Rather than acting as unbiased stewards, the defendant brokers allegedly directed Medicare beneficiaries to the plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability of the MA plans for the beneficiaries. According to the complaint, the broker organizations incentivized their employees and agents to sell plans based on the insurers’ kickbacks, set up teams of insurance agents who could sell only those plans, and at times refused to sell MA plans of insurers who did not pay sufficient kickbacks.”
It’s a start, but the entire MA apparatus needs to be destroyed, root and branch. It’s a testament to the observation that what private enterprise is most efficient at is extracting your money.
Trump DoJ goes after bribery by Medicare Advantage insurers
We both elected not to get Medicare Advantage plans. Not only because we’d read about a higher rate of denial of care for MA plans, but because of the overcharging. If DOGE really wanted to go after a soft target, it would be MA plans. Of course, they won’t, because private enterprise.
Imagine my surprise, then, when I read that the Trump DOJ was going after health insurance companies for corruption:
“The United States filed a complaint today under the False Claims Act (FCA) against three of the nation’s largest health insurance companies — Aetna Inc. and affiliates, Elevance Health Inc. (formerly known as Anthem), and Humana Inc. — and three large insurance broker organizations — eHealth, Inc. and an affiliate, GoHealth, Inc., and SelectQuote Inc. The United States alleges that from 2016 through at least 2021, the defendant insurers paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers’ Medicare Advantage plans.
“Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries may choose to enroll in health care plans (MA plans) offered by private insurance companies, such as defendants Aetna, Anthem, and Humana. Many Medicare beneficiaries rely on insurance brokers to help them choose an MA plan that best meets their individual needs. Rather than acting as unbiased stewards, the defendant brokers allegedly directed Medicare beneficiaries to the plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability of the MA plans for the beneficiaries. According to the complaint, the broker organizations incentivized their employees and agents to sell plans based on the insurers’ kickbacks, set up teams of insurance agents who could sell only those plans, and at times refused to sell MA plans of insurers who did not pay sufficient kickbacks.”
It’s a start, but the entire MA apparatus needs to be destroyed, root and branch. It’s a testament to the observation that what private enterprise is most efficient at is extracting your money.
Trump DoJ goes after bribery by Medicare Advantage insurers
“the entire MA apparatus needs to be destroyed”
Why?
We really like our Kaiser MA plans.
Dave:
They cost more and the profit for healthcare does not deliver as well. In all the times I have written on this, now you ask why MA plans or for profit healthcare sucks?
@Bill,
Maybe it’s time to re-post one or more of those, or at least a couple of links.
An extended version will be there tomorrow. It will include 2024 MedPac data.
@Dave,
Well, it isn’t all about you:
Inflated Risk Scores:
The Department of Justice has accused Kaiser of knowingly submitting inaccurate information that inflated the risk scores of their Medicare Advantage patients, leading to higher reimbursements from the government.
Cancer Coding Issues:
Some lawsuits allege that Kaiser providers have submitted diagnosis codes for active cancer treatment when patients were actually cured, in remission, or the cancer was irrelevant to the services provided.
Avoidance of Retrospective Audits:
The lawsuits further allege that Kaiser has avoided conducting retrospective audits to correct previously submitted false data.
Medicare Advantage is a rip-off for American taxpayers who fund Medicare, whether or not you “really like” it.
Joel:
Tomorrow. Even though I have written it. I still have to recreate if.
Bill
Medicare Advantage costs the government a lot more per patient, and that cost has been rising more quickly than the cost for traditional Medicare. As usual when private enterprise gets involved, costs go up. A lot of it is fraud, but profit is profit.
There’s also the risk that if you actually get seriously sick, Medicare Advantage is more likely to deny payment for treatment than traditional Medicare. Unlike the government program, the private enterprise program may not be there when you need it.
There’s nothing here that wasn’t predicted. You may like your Medicare Advantage plan now, but you have to hope you don’t need it at least not for anything expensive. Meanwhile, Uncle Sam is spending billions more to provide insurers with higher profits.
Kaleberg
You will see something tomorrow on MA and it is extensive. I include some graphs from the 2024 MedPac report also.
Kaleberg:
If you look at the second half of the post, you will see the MedPac charts backing up your comment too.