By Carol Paris, M.D.
The Tennessean, October 30, 2023
Open enrollment goes through Dec. 7. My mailbox is already filling with oļ¬cial-looking letters from commercial insurance companies posing as Medicare.
They tout the advantages of their particular plan while conveniently withholding information that we seniors need and deserve in order to make a truly informed decision about our choice of health insurance.
So what should you know that the billboards, mailers, and Joe Namath TV ads arenāt telling you?
Congressional investigations are exposing problems like up-coding
How about that Senate Finance Committee Chair, Sen. Ron Wyden, D-Oregon, released aĀ report in 2022 confirming deceptive marketing practicesĀ in Medicare Advantage plans and is convening hearings on the matter.
How about that, according toĀ Becker’s Hospital CFO Report, hospitals are dropping Medicare Advantage plans in record numbers due to excessive prior authorization delays and denials of care and slow payment of claims? In the words of Chris Van Gorder, president and CEO of San Diego-based Scripps Health: āPatients need to be aware of how this system works. Traditional Medicare is not an issue. With these other models, seniors need to be wary and savvy buyers.ā
How about that Sen. Bill Cassidy, R-Louisiana, and Sen. Jeff Merkley, D-Oregon,Ā introduced a bill this yearĀ to address the rampant up-coding by Medicare Advantage plans that is draining the Medicare Trust Fund?
Up-coding is the practice of making a patient appear sicker and more complexly ill than they really are for the purpose of getting a higher reimbursement rate for providing that patientās care. āFederal audits have found that taxpayers have been overpaying bad actors running Medicare Advantage plans by billions of dollars every year,ā Merkley said. āThis fraud has to end.ā
Get rid of bad actors in Medicare Advantage
And finally, how about that, along with overpayments due to up-coding, so-called Medicare Advantage plans are robbing taxpayers of an estimated $88 billion to $140 billion dollars a year?
These groundbreaking findings wereĀ reported recently in The Lever,Ā which quoted Physicians for a National Healthcare Program (PNHP) Board Secretary Dr. Ed Weisbart saying: āInsurers are quietly plundering the Medicare trust fund for their own profits and compromising the health of senior citizens and people with disabilities.ā
I can think of several things we could do with that Medicare Trust Fund money like improving the benefits in traditional Medicare, so senior citizens could just choose Medicare and be done with it.
I agree with Senators Cassidy, Merkley, Wyden and others that it is time to end the insatiable greed of bad actors. Tell Congress to get rid of the bad actors in Medicare Advantage and to stop this yearly āopen seasonā on senior citizens.
Dr. Carol Paris is past president and a member of the Board of Physicians for a national health program.