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 Medicare (DIS)Advantage Fraud: Milking the Medicare Trust Fund 

 In Project: Truthseekers - Health Justice Podcast

The U.S. is the only nation that places profiteering middlemen between patients and their doctors. Since its inception, Medicare Advantage has been manipulated by corporate interests as an instrument for wealth transfer upward. The Office of Inspector General for Health and Human Services has reported that fixed monthly capitated payments made to Medicare Advantage on behalf of each patient perversely incentivizes inappropriate denial of healthcare in order to increase insurers' profits, costing the Medicare Trust Fund billions in excess dollars annually for Medicare Advantage plans.

For over 26 years Independent Insurance Broker Christopher Westfall has informed seniors about traditional Medicare and Medicare Advantage on the SeniorSavingsNetwork.org. Westfall relates that brokers are paid commissions twice as high to sell Medicare Advantage plans compared to traditional Medicare supplement plans. In his YouTube Videos, Westfall reports on Medicare Advantage fraud, including widespread misleading television marketing. False information to enrollees often fails to reveal that patients' doctor are not in a Medicare Advantage plan's network, exposing enrollees to substantial out-of-network costs. While traditional Medicare with a supplement plan maintains near full choice of doctors and hospitals and remains unchanged over the years, Medicare Advantage benefits and provider networks may change annually.

The New York Times reported widespread fraud committed by private Medicare Advantage insurers. The Times revealed that Kaiser doctors were offered bottles of Champagne and bonuses by insurers if they added additional illnesses to patient medical records, a practice called "upcoding" that siphons additional money from the Medicare Trust Fund. Congressman Dr. Greg Murphy, M.D. (N.C.) testified before Congress in 2022 about harmful delay and denial effects to healthcare resulting from pre-authorization requirements, another means employed by Medicare Advantage to increase insurance profits.

Former Insurance Executive and whistle blower, Wendell Potter describes commercial Medicare Advantage insurers' practice of "regulatory capture," achieved by pouring huge sums of money into legislators' campaigns in order to discourage any kind of congressional oversight or regulation of commercial insurers.

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Three congress members, Reps. Mark Pocan, Jan Schakowsky and Ro Khanna, reintroduced the Save Medicare Act on February 1, 2023. The Act calls for renaming Medicare Advantage "Private Insurance," as it is not Medicare, nor is it an advantage. Rather Medicare Advantage has been gamed by private insurers to inflate profits by denying healthcare coverage. By design, Medicare Advantage has overcharged health costs by billions of dollars annually, draining the Medicare Trust Fund. In truth, the intent of Medicare Advantage promoters is to privatize traditional Medicare.

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Truthseekers - Health Justice Podcast
More podcasts regarding false corporate narrative surrounding health insurance reform and coverage.

The U.S. is the only nation that places profiteering middlemen between patients and their doctors. Since its inception, Medicare Advantage has been manipulated by corporate interests as an instrument for wealth transfer upward. The Office of Inspector General for Health and Human Services has reported that fixed monthly capitated payments to Medicare Advantage on behalf of each patient perversely incentivizes inappropriate denial of healthcare in order to increase insurers' profits, costing the Medicare Trust Fund billions in excess dollars annually. 

For over 26 years Independent Insurance Broker Christopher Westfall has informed seniors about traditional Medicare and Medicare Advantage on the SeniorSavingsNetwork.org. Westfall relates that brokers are paid commissions twice as high to sell Medicare Advantage plans compared to traditional Medicare supplement plans. In his YouTube Videos, Westfall reports on Medicare Advantage fraud, including widespread misleading television marketing, and misinformation to enrollees, exposing them to substantial out-of-network costs. While traditional Medicare with a supplement plan maintains near full choice of doctors and hospitals and remains unchanged over the years, Medicare Advantage benefits and provider networks may change annually. 

The New York Times has reported widespread fraud committed by private Medicare Advantage insurers, and that Kaiser doctors were offered bottles of Champagne and bonuses by insurers if they added additional illnesses to patient medical records, the practice of "upcoding" that siphons additional money from the Medicare Trust Fund. Congressman Dr. Gregory Murphy, M.D. (N.C.) testified before Congress in 2022 about harmful delay and denial effects to healthcare resulting from pre-authorization requirements. 

Former Insurance Executive and whistle blower, Wendell Potter describes commercial Medicare Advantage insurers' practice of "regulatory capture," achieved by pouring huge sums of money into legislators' campaigns in order to discourage any kind of congressional oversight or regulation of commercial insurers. 

Support the show

Truthseekers - Health Justice Podcast
More podcasts regarding false corporate narrative surrounding health insurance reform and coverage.

The U.S. is the only nation that places profiteering middlemen between patients and their doctors. Since its inception, Medicare Advantage has been manipulated by corporate interests as an instrument for wealth transfer upward. The Office of Inspector General for Health and Human Services has reported that fixed monthly capitated payments made to Medicare Advantage on behalf of each patient perversely incentivizes inappropriate denial of healthcare in order to increase insurers' profits, costing the Medicare Trust Fund billions in excess dollars annually for Medicare Advantage plans.

For over 26 years Independent Insurance Broker Christopher Westfall has informed seniors about traditional Medicare and Medicare Advantage on the SeniorSavingsNetwork.org.  Westfall relates that brokers are paid commissions twice as high to sell Medicare Advantage plans compared to traditional Medicare supplement plans. In his YouTube Videos, Westfall reports on Medicare Advantage fraud, including widespread misleading television marketing. False information to enrollees often fails to reveal that patients' doctor are not in a Medicare Advantage plan's network, exposing enrollees to substantial out-of-network costs. While traditional Medicare with a supplement plan maintains near full choice of doctors and hospitals and remains unchanged over the years, Medicare Advantage benefits and provider networks may change annually, or more often.

The New York Times has reported widespread fraud committed by private Medicare Advantage insurers. The Times revealed that Kaiser doctors were offered bottles of Champagne and bonuses by insurers if they added additional illnesses to patient medical records, a practice called "upcoding" that siphons additional money from the Medicare Trust Fund. Congressman Dr. Gregory Murphy, M.D. (N.C.) testified before Congress in 2022 about harmful delay and denial effects to healthcare resulting from pre-authorization requirements, another means employed by Medicare Advantage to increase insurance profits. 
 
Former Insurance Executive and whistle blower, Wendell Potter describes commercial Medicare Advantage insurers' practice of "regulatory capture," achieved by pouring huge sums of money into legislators' campaigns in order to discourage any kind of congressional oversight or regulation of commercial insurers.

Support the show

Truthseekers - Health Justice Podcast
More podcasts regarding false corporate narrative surrounding health insurance reform and coverage.

Four doctors address the effects of the lack of universal health care in the U.S. and the fact that the U.S. spends 1.7 to 2 times more than any other nation, and has worse health outcomes.

The U.S. fractured Social Compact contrasts with every other developed nation, all of which prioritize universal health care. In a 2016 TEDx Talk, Dr. Anthony Iton contrasts the Social Compact of Canada, where he grew up, with the U.S. lack of Social Compact. Upon arriving at Johns Hopkins Medical to study medicine, he is stunned by the atrocious condition of Baltimore inner city, prompting the question "Does your zip code matter more than your genetic code?" regarding U.S. health.

Dr. Alison Galvani, Epidemiologist led a 2020 Study of Medicare for All at the Yale School of Public Health, published in the medical journal The Lancet Health Policy, Feb. 15, 2020. One of the most recent of numerous studies of Medicare for All, the Study revealed savings of $450 billion annually with greatly reduced administrative costs of the single-risk-pool insurance that would cover all U.S. residents.

Drs. Abdul El-Sayed and Micah Johnson in a February 22, 2021 presentation to the Commonwealth Club of California reported findings of their book, Medicare for All: A Citizen's Guide. The authors speak to the powers lined up against universal health care in the U.S. They address the relationship between health care access and other social determinants, e.g., housing, food security and good jobs. They lay out the ways that Medicare for All could remedy inequities in the U.S. health care system.

Previous Podcast - Private Equity Healthcare: Commodification of Human Health - Wall St. takeover of health care for profit.

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The takeover of management of many sectors of healthcare by Wall St. Private Equity firms, Hedge Funds and other corporate investors over a period of decades, coincides with worsening U.S. health outcomes - e.g., reduced life expectancy and increased maternal and child mortality.  In order to inflate profits, investment management firms commonly cut staffing, pay, benefits, and short equipment, even as some board-certified emergency physicians are replaced with less qualified practitioners. Such tactics as "surprise billing," "upcoding" or exaggerating patient condition for greater profit,  "fee-splitting" and corporate practice of medicine are commonly employed to extract greater profits.  Traditional Medicare is currently targeted in a program initiated by the Trump administration, whose "Direct Contracting Entities" (DCEs) place profiteering middlemen between traditional Medicare recipients and their doctors. DCEs have been rebranded by the Biden administration the "REACH" program, with the same goal to privatize traditional Medicare, moving traditional Medicare recipients without their consent or knowledge into privatized coverage with private equity or other for-profit corporate entity.   Call to end the effort to privatize traditional Medicare: Message Line of HHS Secretary Becerra: 202-205-5445. White House Message Line: 202-456-1111.

More Podcasts at: Truthseekers - Health Justice Podcast  - Examining the false corporate narrative surrounding U.S. health insurance reform.

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 The Medicare Modernization Act of 2003 was designed to enhance the bottom line of big PhRMA and Medicare Advantage health insurers. The Act set the stage for subsequent efforts by the health care industry in collaboration with Congress to privatize Medicare.

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 The U.S. is the only advanced country that prioritizes profit over healthcare access. Retired Emergency Medicine Specialist Dr. Vincent Markovchick remarks that the U.S. has the costliest health insurance model, with numerous segments of the economy milking large profits. Ever larger shareholder profits are sought by venture capitalist investor-owned health groups. Those seeking healthcare run the risk of out-of-network "surprise billing" by investor-owned free-standing emergency rooms, doctor groups, hospice centers, emergency air rescue groups, etc. Even media took in $5.2 billion in a single year for pharmaceutical ads, motivation to defend the status quo. Groups making large profits from healthcare are lining up against Medicare-for-All in order to protect their profits.

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In response to high morbidity and mortality rates caused by an environmental health disaster due to asbestos mining in Libby and northwest Montana, Sen. Max Baucus added a section, Amendment 1881 A to the Social Security Act as a provision to the Affordable Care Act as it was drafted in 2009-10. The intent was to enroll everyone in the affected areas of Libby, Montana and the northwest area of the state in the national Medicare program - without qualifications.

The model of provision of Medicare for All to Libby, Montana provides a roadmap to the extension of healthcare to all who are subject to COVID-19 virus and other health threats.

Produced at Denver Open Media by Michele Swenson

More Truthseekers - Health Justice Podcasts

Support the show (https://www.denveropenmedia.org/podcast/library#truthseekers)

 The U.S. is the only advanced country that prioritizes profit over healthcare access. Retired Emergency Medicine Specialist Dr. Vincent Markovchick remarks that the U.S. has the costliest health insurance model, with numerous segments of the economy milking large profits. Ever larger shareholder profits are sought by venture capitalist investor-owned health groups. Those seeking healthcare run the risk of out-of-network "surprise billing" by investor-owned free-standing emergency rooms, doctor groups, hospice centers, emergency air rescue groups, etc. Even media took in $5.2 billion in a single year for pharmaceutical ads, motivation to defend the status quo. Groups making large profits from healthcare are lining up against Medicare-for-All in order to protect their profits.

Produced at Denver Open Media by Michele Swenson

More Truthseekers - Health Justice Podcasts

Support the show (https://www.denveropenmedia.org/podcast/library#truthseekers)