This article discusses the ongoing privatization of Medicare and how private insurers are making significant profits through systematic overbilling and opposition to measures aimed at stopping the practice. It focuses on Humana, a prominent health insurance company, which earned $2.8 billion in profits in 2022 due to overpayments from the federal government for Medicare Advantage plans.
These overpayments are part of a broader agenda to privatize Medicare and lock program recipients into subpar private insurance plans. Medicare Advantage plans have higher claim denial rates and more restrictions than traditional Medicare, and insurers engage in "upcoding" schemes to overbill for services. The overpayment problem puts the financial stability of Medicare at risk, with billions of dollars being redirected to insurers instead of benefiting program recipients. Major insurers like UnitedHealth, Centene, and CVS Health also benefit from Medicare Advantage overpayments. The inability to crack down on overpayments is attributed to aggressive lobbying by the insurance industry, which has influenced government proposals and rate increases.
The article emphasizes the need to address the imbalance between Medicare Advantage and traditional Medicare, highlighting the advantages of the latter in terms of patient care. The growth of Medicare Advantage poses challenges in reining in the industry, and the article calls for attention to the issue and advocacy for a fair and cost-effective Medicare system for all beneficiaries.
Full article from The Lever here.