The $20 Billion Scam At The Heart Of Medicare Advantage

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The health insurance behemoth Humana enjoyed a banner 2022. The Louisville, Ky.-based insurer made $2.8 billion in profits last year, while paying out $448 million in dividends to shareholders and more than $17 million in compensation to its CEO.

The main driver of those earnings? The federal government spent $20.5 billion overpaying Humana and other private insurers for the Medicare Advantage plans they manage on behalf of seniors and people with disabilities. If not for those overpayments, Humana could have suffered a nearly $900 million loss in 2022, according to a Lever analysis.

Humana is the most prominent example of how insurers have built a major cash cow out of systematically overbilling Medicare Advantage, the private Medicare program operated by private interests. These overpayments are symptomatic of a broader profit-driven policy agenda that seeks to completely privatize Medicare, one of the nation’s most popular social programs, and lock program recipients into subpar private insurance plans, even when they get sicker and need the best care possible.

Medicare Advantage plans have higher claim denial rates and more prior authorization restrictions than traditional Medicare plans. Last year, regulators found that nearly one in five payment requests rejected by Medicare Advantage plans in 2018 were wrongfully denied, representing an estimated 1.5 million claims.

And while Biden administration proposals could have helped slow the for-profit takeover by tightening the screws on Medicare Advantage overpayments, insurers recently led a fierce lobbying campaign to dissuade the government from fully cracking down on the practice.

At the root of Medicare Advantage overpayments is “upcoding” by insurers, a scheme by which the companies systematically overbill the public as if their patients are sicker than they really are. Companies have offered bottles of champagne and bonuses to entice doctors to add diagnoses to patients’ records, according to government lawsuits reviewed by the New York Times.
https://www.levernews.com/the-20-billio ... advantage/

Who does the Medical insurance companies think they are, Rick Scott? When I was working in Home Health the fastest way to lose you Medicare license was to get caught upcoming.
Facts do not cease to exist because they are ignored.-Huxley
"We can have democracy in this country, or we can have great wealth concentrated in the hands of a few, but we can't have both." ~ Louis Brandeis,

Re: The $20 Billion Scam At The Heart Of Medicare Advantage

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My taxable-income gig is a block or two from the Hugeugly, er, Screwmana, er, Humana headquarters. They have earned the scorn of many over the years.

For-profit "medical insurance" is a horrible waste of the country's resources, but people seem to think that single-payer health insurance would be a bad thing.

Never mind that we're one of the very few "developed" countries that don't have single-payer.
Eventually I'll figure out this signature thing and decide what I want to put here.

Re: The $20 Billion Scam At The Heart Of Medicare Advantage

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Same thread we see a few times a year. Medicare Advantage covers about 39% of Medicare recipients, 21% have a Medigap or supplement on top of Medicare, 18% have employer sponsored insurance, 12% have Medicaid on top of Medicare and 10% have no supplemental coverage.
https://www.kff.org/medicare/issue-brie ... in%202018.

Some Medicare Advantage plans are garbage, some Medigap/Supplement plans are garbage, buyer beware.

A huge problem that gets little attention, "How doctors buy their way out of trouble".
https://www.reuters.com/investigates/sp ... ttlements/
"Everyone is entitled to their own opinion, but not their own facts." - Daniel Patrick Moynihan

Re: The $20 Billion Scam At The Heart Of Medicare Advantage

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We need single payer government funded health care. Unfortunately, when I see what corporate interests have done to Medicare in the form of these advantage and supplement plans I fear what form single payer would take in the US. Not saying we shouldn't try. We need to try and we need to enact much larger changes to the political process or any single payer system we get will turn into another corporate giveaway.

Re: The $20 Billion Scam At The Heart Of Medicare Advantage

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papajim2jordan wrote: Wed Nov 06, 2024 8:11 am Trump will fix it.
He will leave that up to the next Senate Majority leader Rick Scott. Scott’s prior tenure as CEO of Columbia/HCA about a decade ago, when the hospital company was fined $1.7 billion for Medicare fraud. Scott is the Fox in the henhouse.
Facts do not cease to exist because they are ignored.-Huxley
"We can have democracy in this country, or we can have great wealth concentrated in the hands of a few, but we can't have both." ~ Louis Brandeis,

Re: The $20 Billion Scam At The Heart Of Medicare Advantage

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TrueTexan wrote: Wed Nov 06, 2024 8:20 am
papajim2jordan wrote: Wed Nov 06, 2024 8:11 am Trump will fix it.
He will leave that up to the next Senate Majority leader Rick Scott. Scott’s prior tenure as CEO of Columbia/HCA about a decade ago, when the hospital company was fined $1.7 billion for Medicare fraud. Scott is the Fox in the henhouse.
That fucking guy. That Florida has repeatedly elected such a blatant fraudster never fails to amaze me. Idiots think Ds are "soshulist" but they love corporate whores stealing government money hand over fist.
IMR4227: Zero to 900 in 0.001 seconds

I'm only killing paper and my self-esteem.

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