At the end of March, the U.S. Justice Department joined a lawsuit brought by a whistleblower alleging that UnitedHealth Group committed fraud in its Medicare Advantage (commercial insurance that covers Medicare benefits) business. The charge is that UnitedHealth misrepresented the health status of its subscribers to Medicare in order to increase its Medicare payments.
Kaiser Health News reports that the breadth of UnitedHealth Group’s alleged fraud is significant. Damages could be more than $1 billion. That said, an investigation by the Center on Public Integrity suggests that fraud and overbilling by Medicare Advantage plans may be costing taxpayers tens of billions of dollars. The Government Accountability Office (GAO) has also reported on significant billing concerns with Medicare Advantage plans.
When Congress expanded Medicare to include commercial health plan options, the claim was that these plans could bring down Medicare costs significantly. In fact, these plans have restricted people’s choice of doctors and hospitals and driven up out-of-pocket costs significantly for people with complex conditions. In addition, the Medicare Payment Advisory Commission (MedPAC) has found that taxpayers continue to spend more per person in Medicare Advantage plans than in traditional Medicare.
Less than a third of people with Medicare are enrolled in Medicare Advantage plans, in part because they restrict people’s access to care and can leave members with costly care needs paying well over $6,000 a year for in-network care plus thousands more if they use out-of-network doctors, which they too often have no choice but to do. But, traditional Medicare requires people have supplemental coverage in order to fill gaps and budget for their care. So, people who believe that they will not need care in the foreseeable future may choose a Medicare Advantage plan to save on the cost of supplemental coverage.
Here’s more from Just Care:
- Four key differences between traditional Medicare and a Medicare Advantage plan
- Medicare Advantage plan prior approval rules could stick you with big bills
- How to protect yourself against unexpected medical bills
- Free local resources for older adults
- If your income is low, here are four programs that could help