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Numerous major U.S. health insurance companies have made as much as $25 billion in profits by fraudulently billing the U.S. government for nonexistent healthcare charges, according to a New York Times report.
By 2023, nearly half of the estimated 64 million people on Medicare — the government’s national health insurance program for people over 65 and young people with disabilities — will have a Medicare Advantage (MA) plan. The MA plans, managed by private insurance companies, receive payments from the U.S. government for managing people’s care.
Whistleblowers, federal officials, and an inspector general accused some of the biggest insurers of fraudulently overbilling the government by falsely reporting patient ailments. The accused companies include UnitedHealth, Humana, CVS Health, Kaiser Permanente, Cigna, and others. Most of the programs’ large insurers have also been accused of fraud in court.
Two decades ago, congressional Republicans created MA “to encourage health insurers to find innovative ways to provide better care at lower cost,” the Times wrote. However, the MA program now costs more money per patient than those enrolled in Medicare.
Journalist Natalie Shure explained how the scam works.