Doctors call for shutdown of hopelessly compromised Medicare REACH program

FOR IMMEDIATE RELEASE: January 9, 2022

Media Contact: Gaurav Kalwani, PNHP communications specialist, gaurav@pnhp.org

Physicians for a National Health Program (PNHP), an organization of over 26,000 physicians who support publicly financed Medicare for All, commends 21 members of Congress who sent a letter to CMS Administrator Chiquita Brooks-LaSure raising serious concerns about the ACO REACH program, based on initial research by PNHP.

ACO REACH, which is set to begin officially operating in January, is a redesigned version of the Trump administration’s Medicare Direct Contracting program that allows third-party entities (often private insurers) to administer traditional Medicare benefits. The Congressional letter, led by Senator Elizabeth Warren and Representative Pramila Jayapal, describes documented histories first collected by PNHP of bad behavior by numerous insurers set to participate in the program. These companies faced allegations of overcharging Medicare and Medicaid, inflating diagnoses, misleading seniors through dubious marketing, and more, often paying tens or even hundreds of millions of dollars to federal and state governments in settlements and fines.

The letter urges CMS to halt participation of any insurers that have previously settled allegations of health care fraud, and expel from the program the insurers who do not meet its new standards. It also seeks clarification from CMS as to the screening process for participants in the program, and what steps the agency is taking to protect Medicare beneficiaries and taxpayers from waste, fraud, and abuse.

“As Medicare advocates have been saying over the past year, ACO REACH is nothing more than a fresh coat of paint on Medicare privatization,” said Dr. Phil Verhoef, an adult and pediatric intensivist and president of Physicians for a National Health Program. “It further opens the door for private insurers to make money at the expense of our public health programs and those who benefit from them. We applaud these members of Congress for raising the alarm on the most egregious profiteers operating in the Medicare space, and continue to call for CMS to shut REACH down for good.”

For more information on the REACH program and the danger it presents to our public insurance programs, please visit protectmedicare.net. 

Physicians for a National Health Program (pnhp.org) is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform.