Overbilling

We have noted from time to time the issue of Medicare Advantage as part of UC's offerings of retiree health insurance. Medicare Advantage plans are privatized versions of Medicare. In principle, they provide whatever benefits traditional Medicare would provide, but with add-ons such as gym memberships.

Insurance companies have aggressively gone after Medicare Advantage business with TV ads, etc., all of which suggests they are being overpaid by Medicare, particularly because they are offering bargain rates to participants. Congress is getting curious about all of this and is coming to believe it is providing an excess subsidy. From the Wall St. Journal:

Sen. Chuck Grassley, chairman of the Senate Judiciary Committee, sent UnitedHealth Group CEO Andrew Witty a letter demanding detailed information on the company’s Medicare billing practices [last] Monday. The letter—which cited findings from a series of Wall Street Journal articles published over the last year—said “the apparent fraud, waste, and abuse at issue is simply unacceptable and harms not only Medicare beneficiaries, but also the American taxpayer.”

A Journal data analysis found UnitedHealth was paid billions of dollars based on diagnoses the company added to patients’ Medicare records, even though their doctors hadn’t treated the conditions. Under Medicare Advantage, the private version of the federal program, the insurers that oversee patients’ benefits get bigger payments when people are diagnosed with certain illnesses...

Full story at https://www.wsj.com/health/healthcare/sen-grassley-launches-inquiry-into-unitedhealth-groups-medicare-billing-practices-ad63a53c.

As blog readers will know, at one point UC wanted to put all of its Medicare-eligible retirees into a Medicare Advantage plan. After a brouhaha about that goal, the system instead offered a Medicare Advantage program through UnitedHealthcare as a low-cost UC option. Whether it can remain a low-cost option remains to be seen.