Tag Archives: Medicare Advantage

‘This Should Be a National Scandal’: For-Profit Medicare Advantage Plans Using AI for Denials

“They’re using AI to predict when to cut off payment for treatments,” said one watchdog group. “We repeat, AI. Not a doctor.”

By Brett Wilkins. Published 11-3-2023 by Common Dreams

*Single payer protest in Baltimore, MD Photo: Elvert Barnes/flickr/CC*

As Medicare Advantage plans rely increasingly upon artificial intelligence to determine—and often deny—payment for patient care, a group of Democratic U.S. lawmakers on Friday urged Medicare’s top official to strengthen oversight of AI and algorithmic tools used to make coverage determinations.

“In recent years, problems posed by prior authorization have been exacerbated by MA plans’ increasing use of AI or algorithmic software to assist in their coverage determinations in certain care settings, including inpatient hospitals, skilled nursing facilities, and home health,” 32 House Democrats led by Rep. Judy Chu (D-Calif.) wrote in a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Books LaSure.

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Medicare Advantage Overbills Taxpayers by $140 Billion a Year—Enough to Wipe Out Medicare Premiums

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“Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare,” says a new report from Physicians for a National Health Program.

By Jake Johnson. Published 10-4-2023 by Common Dreams

A report published Wednesday estimates that privately run, government-funded Medicare Advantage plans are overcharging U.S. taxpayers by up to $140 billion per year, a sum that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare’s prescription drug program.

Physicians for a National Health Program (PNHP), an advocacy group that supports transitioning to a single-payer health insurance system, found that Medicare Advantage (MA) overbills the federal government by at least $88 billion per year, based on 2022 spending.

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As Scandals Mount, So Do Calls to Abolish Private Medicare Advantage Plans

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“Problems with Medicare Advantage are systemic and widespread,” said Rep. Pramila Jayapal. “Not only do they too often deny care—they’re ripping off taxpayers.”

By Brett Wilkins. Published 12-13-2022 by Common Dreams

Photo: K Whiteford/Public domain

As yet another scandal involving Medicare Advantage made headlines this week, progressive U.S. lawmakers and advocates renewed calls to abolish the private health insurance program that a recent Senate report said is “running amok” with “fraudsters and scam artists.”

In a new Nation article written with health insurance reform advocate Wendell Potter, Reps. Ro Khanna (D-Calif.) and Mark Pocan (D-Wis.) contend that one of the most confusing things facing elders while choosing their Medicare plans “is a scheme by private insurance companies to prey on seniors and profit off of the Medicare brand, all in the name of padding their corporate profits and shareholder returns.” Continue reading →

Austin AFL-CIO Council Becomes Latest to Urge Biden to End Medicare Privatization Scheme

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The labor council’s newly passed resolution warns that the scheme “allows doctors and their offices to convert a patients’ traditional Medicare choice into ACO-REACH coverage without first informing their patients.”

By Jake Johnson Published 11-21-2022 by Common Dreams

Health and Human Services Secretary Xavier Becerra. Photo: Gage Skidmore/flickr/CC

The labor council of the Austin, Texas AFL-CIO has passed a resolution urging the Biden administration to terminate a Medicare privatization scheme that is quietly moving ahead despite vocal opposition from doctors, seniors, and progressive lawmakers.

The pilot program, which inserts private middlemen between patients and healthcare providers, was unveiled with little notice during the final months of the Trump administration despite internal concerns about its legality. The experiment has since been largely upheld by the Biden administration, which announced mostly cosmetic changes earlier this year, winning applause from industry groups that lobbied against complete elimination of the program. Continue reading →

‘Straight Up Fraud’: Data Confirms Private Insurers Use Medicare Advantage to Steal Billions

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“The move to privatize Medicare,” said one expert, has “been very profitable, in part because insurers are good at making their patients seem sicker.”

By Kenny Stancil Published 10=9-2022 by Common Dreams

Photo: K Whiteford/Public domain

Insurance giants are exploiting Medicare Advantage—a corporate-managed program that threatens to result in the complete privatization of traditional Medicare—to capture billions of dollars in extra profits, Saturday reporting by The New York Times confirmed.

The newspaper’s analysis of dozens of lawsuits, inspector general reports, and watchdog investigations found that overbilling by Medicare Advantage (MA) providers is so pervasive it exceeds the budgets of entire federal agencies, prompting journalist Ryan Cooper to call the program “a straight up fraud scheme.” Continue reading →

‘Staggering’: Watchdog Finds Medicare Advantage Plans Deny Necessary Care

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“These plans are designed to maximize profits for corporations, NOT to provide high-quality healthcare,” said Social Security Works.

By Jessica Corbett Published 4-28-2022 by Common Dreams

Photo: Myfuture.com/flickr/CC

A government watchdog revealed Thursday that Medicare Advantage plans—which are offered by private companies but required to follow rules set by the government healthcare program—deny medically necessary care to tens of thousands of enrollees each year.

The revelation came in a report released by the U.S. Department of Health and Human Services Office of Inspector General (OIG), which examined a random sample of 250 prior authorization denials and 250 payment denials issued by 15 of the largest Medicare Advantage Organizations (MAOs) during the first week of June in 2019. Continue reading →

Advocates Sound Alarm Over Quiet Trump Era Move That Could Further Privatize Medicare

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“The Biden administration should immediately kill this toxic legacy of the former president.”

By Jake Johnson, staff writer for Common Dreams. Published 3-13-2021

Seema Verma, administrator of the Centers for Medicare and Medicaid Services during the Trump administration. Photo: Paul Morigi/flickr/CC

A little-noticed scheme hatched in the late stages of the Trump presidency has consumer advocates and universal healthcare proponents warning about a creeping attempt to further privatize Medicare—an effort the Biden administration is being urged to stop in its tracks.

On December 3, the Centers for Medicare and Medicaid Services (CMS)—then under the leadership of Seema Verma—unveiled an innocuous-sounding proposal titled the Geographic Direct Contracting Model (Geo) with the purported goal of delivering “Medicare beneficiaries value through better care and improved quality.” Continue reading →

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Tag Archives: Medicare Advantage