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Trump Opens the Door to More Medicare Advantage Fraud -- The American Prospect
https://prospect.org/health/2025-04-11-trump-opens-door-more-medicare-advantage-fraud/Ryan Cooper
Private insurance companies just got a massive boost to their payments through the program, while DOGE fires the people responsible for oversight.
. . .
Under Medicare Advantage—which now covers more than half of the seniors in the program—the government pays private companies to insure Medicare enrollees. As we have covered at the Prospect for years now, the program is, at best, a pointless waste of money, and at worst an outright scam. It was set up back in the 1990s at the height of bipartisan neoliberal hegemony, when virtually everyone in power assumed as a matter of faith that business could always operate more efficiently than government, amen.
. . .
Private insurers responded to that by rigging the codes. They pressure doctors in various ways to pile lots of dubious or fake diagnoses on healthy people, so they can get a larger risk-adjusted payout without actually having to fund treatment. This practice cost the government an estimated $50 billion in 2024.
. . .
So there will be many fewer regulators looking over the shoulders of insurers and hospitals, and the rewards for cheating the system have been greatly increased. Even if they do get caught—like the hospital conglomerate Sen. Rick Scott (R-FL) used to run, which back in 2000 was fined $1.7 billion for the largest Medicare fraud in history at the time (including, you guessed it, rampant upcoding and fake diagnoses)—they can just run to Trump with a bribe sack full of gold doubloons and get a pardon. It worked for Trevor Milton!
If and when Medicare spending skyrockets along with the budget deficit, and the money vanishes into the pockets of a handful of crooked executives and shareholders, we know who to blame: Donald Trump.
Under Medicare Advantage—which now covers more than half of the seniors in the program—the government pays private companies to insure Medicare enrollees. As we have covered at the Prospect for years now, the program is, at best, a pointless waste of money, and at worst an outright scam. It was set up back in the 1990s at the height of bipartisan neoliberal hegemony, when virtually everyone in power assumed as a matter of faith that business could always operate more efficiently than government, amen.
. . .
Private insurers responded to that by rigging the codes. They pressure doctors in various ways to pile lots of dubious or fake diagnoses on healthy people, so they can get a larger risk-adjusted payout without actually having to fund treatment. This practice cost the government an estimated $50 billion in 2024.
. . .
So there will be many fewer regulators looking over the shoulders of insurers and hospitals, and the rewards for cheating the system have been greatly increased. Even if they do get caught—like the hospital conglomerate Sen. Rick Scott (R-FL) used to run, which back in 2000 was fined $1.7 billion for the largest Medicare fraud in history at the time (including, you guessed it, rampant upcoding and fake diagnoses)—they can just run to Trump with a bribe sack full of gold doubloons and get a pardon. It worked for Trevor Milton!
If and when Medicare spending skyrockets along with the budget deficit, and the money vanishes into the pockets of a handful of crooked executives and shareholders, we know who to blame: Donald Trump.
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