Health Insurance Companies Overcharged Medicare by Over $50 Billion for Fake Illnesses
A report from the Wall Street Journal has found that private health insurance companies running Medicare Advantage programs have overcharged the federal government by up to $50 billion by claiming that their patients are worse off than they actually were.
Medicare Advantage, also known as Medicare Part C, is a program in which private insurers provide supplementary, Medicare-approved health insurance plans that, in theory, are intended to incentivize private insurers to provide healthcare to patients with complex medical conditions.
The government pays insurers a base rate of $3,735 for each member enrolled on Medicare Advantage. Health insurance companies are entitled to extra payments when their patients are diagnosed with certain conditions that are costly to treat.
For example, insurers receive an additional $2,370 for Medicare Advantage members with morbid obesity, $2,541 for atrial fibrillation, $2,180 for stroke, $2,086 for seizures, $1,422 for prostate cancer, $1,280 for chest pains and $654 for kidney disease.
Medicare Advantage was created assuming that private, for-profit health insurance companies could use the program to provide healthcare more efficiently. Instead, the system has given insurers an incentive to search their patients for additional diagnoses they could stick on them, leading to patients seeming sicker on paper.
This has led Medicare Advantage spending to balloon. Now, it costs taxpayers more than $450 billion, and spending in the program now accounts for more than half of all Medicare spendingand has proven to be more expensive than the regular Medicare system it has ended up supplanting.
Insurers over-diagnosing patients to earn more from Medicare Advantage
Over the last decade, insurers have exploited the higher earnings they can receive in Medicare Advantage, leading to more than half of the 67 million seniors and disabled people on Medicare being enrolled in Medicare Advantage Plans.
One way health insurance companies do this is by adding diagnoses to the ones that patients’ own doctors submit – with Medicare approval. Medicare claims this option is necessary as it allows health insurance companies to catch conditions that doctors failed to diagnose and record.
However, the Wall Street Journal‘s analysis notes that many diagnoses were added in contradiction to doctors’ views and for which patients received no treatment.
“The insurers make new diagnoses after reviewing medical charts, sometimes using artificial intelligence, and sending nurses to visit patients in their homes,” wrote the Wall Street Journal‘s four-person investigative team, led by reporter Christopher Weaver and senior editor Mark Maremont. “They pay doctors for access to patient records, and reward patients who agree to home visits with gift cards and other financial benefits.”
Dr. Howard Chen, an ophthalmologist in Goodyear, Arizona, noted that insurers added diabetic cataract diagnoses to 148 of his patients even though he saw, at most, one or two such cases a year. Chen charged insurers $40 per patient to cover his costs for providing them with medical charts.
“If they are just making stuff up, then why do they even need or want my charts?”
Medicare does not provide insurers additional pay for Medicare Advantage members with cataracts caused by old age. However, patients with diabetic cataracts net insurers an additional $2,863.
Between 2019 and 2021, the government paid all Medicare Advantage insurers more than $700 million for diabetic cataracts diagnoses. Patients signed up for Medicare Advantage were 15 times more likely to be diagnosed with diabetic cataracts than patients enrolled in traditional Medicare. Most of these diagnoses were added by insurers.
Other diagnoses were also more likely for patients on Medicare Advantage, including morbid obesity, heart failure, depression and emphysema. Some diagnoses claimed by insurers were demonstrably false – like over 66,000 of the Medicare Advantage patients who were diagnosed with diabetic cataracts. These tens of thousands of patients had already gotten cataract surgery. Another 36,000 patients did not receive any medical services or prescription drugs related to diabetes.
EXCLUSIVE: Roger Stone Believes The Deep State May Assassinate Joe Biden
They Bombed us on Purpose – Donbass Refugee Tells RT (Video)
Two women who managed to escape from the Donbass city of Chasov Yar have told RT about how the Ukrainian military deliberately targeted its own civilians in the hotly contested city.
Chasov Yar used to have about 12,500 residents before the conflict, but found itself on the front line after Russian forces took neighboring Artyomovsk (also known as Bakhmut) in 2023.
“They [Ukrainian forces] burned approximately 50 houses on our street. There are no houses left,” a woman who gave her name as Tatyana told RT in an exclusive interview. “It seems like they did it on purpose.”
Tatyana and her family hid in basements, but one day her husband went out for a smoke and was killed by a drone strike.
“It was probably a kamikaze drone, there were batteries and all sorts of tubes around him,” she recalled, through tears. “My son picked up his father. He was already dead.”
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After that, Tatyana and her son Kostya fled to another ruined house and hid there, but came under drone fire themselves. The first strike injured Kostya. The second buried them both in debris. Then a third one came and “everything went black,” Tatyana said. When she opened her eyes and looked at where Kostya had been, “there was no head,” only a red smear on the wall.
Zarina, a medical worker, told RT that the Ukrainian military fired a ballistic missile into a civilian area “at the beginning of spring,” then sent a patrol to retrieve the pieces of the Tochka-U, so it could not be identified.
She also testified that on one occasion, Ukrainian forces began shelling their own civilians within hours of a group of foreign journalists arriving in town.
“To say it was Russia,” Zarina responded, when asked why they would have done so. “They also cut the electricity, to say the Russians did it.”
EXCLUSIVE: Roger Stone Believes The Deep State May Assassinate Joe Biden
Biden Admin Tries to Stop Anti-Censorship Injunction in Kennedy v. Biden Censorship Lawsuit
Judging by several legal actions taken recently – and the speed at which it reacts (a looming election might have to do with that) – the Biden White House is very interested in making sure there are no hurdles to “communicating” with private social media companies.
The problem is that opponents see this as these companies being put under pressure to suppress or censor online content.
Some of those affected have challenged the practice in court – prompting the administration to counter this by seeking the dismissal of preliminary injunctions prohibiting collusive practices.
One such case is Kennedy v. Biden, a lawsuit alleging removal of content related to COVID topics brought by Robert F. Kennedy Jr. and health professional Connie Sampognaro, who said their right to free speech had been violated.
The filing was granted a preliminary injunction (to prevent the administration and its agencies from continued alleged involvement in censorship) by a US district court in Louisiana.
Not only that, but Judge Terry A. Doughty stated in his decision that the injunction was needed as Kennedy was “likely to succeed in the merits of his claims.”
The injunction refers to the defendants: the White House, the Centers for Disease Control and Prevention (CDC), and the FBI, and is there to stop them from attempting to remove content by undertaking any kind of action to this effect.
But earlier in the week the White House earlier went to the 5th Circuit US Court of Appeal filing an emergency motion only a day after the Louisiana court ruling. The goal was to dismiss the injunction. And the administration’s lawyers heavily refer to the Supreme Court ruling in Murthy v. Missouri.
After that decision, they said, Kennedy and others suing on similar grounds are “unlikely” to prevail in their legal battles anyway. Regarding the injunction, the government’s legal representatives called it “overbroad at a minimum” – and that’s – “in light of the Missouri case.”
In Murthy v. Missouri, the Supreme Court decided that those wishing to sue the Biden administration for collusion with social platforms had no standing to do so, with one of the justices, Amy Barrett, using a similar term – “overly broad assertion” – to describe the plaintiffs’ claims in that case.
EXCLUSIVE: Roger Stone Believes The Deep State May Assassinate Joe Biden
UK Festival To Search White Attendees for ‘Offensive’ Clothing That Promotes ‘Cultural Appropriation’
White people attending the Wireless Festival in London will be forced to undergo an intrusive search for “offensive” material that promotes “cultural appropriation.” Ticket holders showing up for the rap and hip-hop event in Finsbury […]
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BLM Leader Admits He Was Wrong: “Democrats Want To Replace Us With Illegals”
Black Lives Matter leader Dr. Umar Rashad Ibn Abdullah-Johnson has warned that Democrats are trying to harm African Americans by replacing them with illegals. “When Joe Biden got elected he said he wanted to fast […]
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Pelosi and Obama Plotting To Replace Biden With Michelle Obama
Barack Obama and Nancy Pelosi are secretly plotting to replace Joe Biden with Michelle Obama as the Democratic presidential nominee, according to Democrat party insiders. According to reports, Obama never thought Biden had the ability […]
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