Highway Robbers of Medicare Advantage

Sep 16, 2024

Health insurers pocketed $50 billion from Medicare for diseases no doctor treated, as the Wall Street Journal recently found out. These big-time robbers are among the largest companies in the world, including UnitedHealthcare, Humana, Anthem, and BlueCross BlueShield.

Since Medicare pays Medicare Advantage health insurers more for sicker patients, the insurers are “incentivized” to find more sickness. They send nurses to peoples’ homes, under the guise of a free health evaluation. They instruct these nurses to diagnose diseases that people don’t have and sometimes cannot have.

In one example, the Wall Street Journal found that health insurers diagnosed more than 66,000 Medicare Advantage patients with diabetic cataracts, a relatively rare disease, even though these patients cannot have cataracts because their lenses have already been previously replaced through cataract surgery. The health insurers jacked up charges to the government by about $2,700 more each year per insured member diagnosed, anyway.

Such phony diagnoses by the health insurers even included deadly diseases, such as AIDS. Although the insured were diagnosed with AIDS by health insurers, they received no subsequent care. Often, neither the patients nor their doctors had any idea about such a severe diagnosis. Later, the physicians determined that their patients did not really have AIDS. But the insurers charged the federal government and got paid anyway.

In total, Medicare paid these giant insurance companies about 50 billion dollars for bogus diagnoses in the three years ending in 2021.