Skip to main content

Sign up for our newsletter.

Quality journalism. Progressive values. Direct to your inbox.

A senior woman is pictured in an intensive care unit

A senior woman is seen lying in a bed in an intensive care unit. (Photo: iStock/Getty Images)

Wyden Launches Probe Into Deceptive Marketing by Medicare Advantage Plans

"Unfortunately, false or misleading advertisements and fraudulent sales practices are not new issues for Medicare beneficiaries," said the chair of the Senate Finance Committee.

Kenny Stancil

Sen. Ron Wyden on Tuesday launched an inquiry into "potentially deceptive" marketing tactics being used by private insurers and other companies that offer Medicare benefits through Medicare Advantage and Part D prescription drug plans, citing "alarming reports" about contractors "engaging in aggressive sales practices that take advantage of vulnerable seniors and people with disabilities."

In his capacity as chair of the Senate Finance Committee, which has jurisdiction over federal healthcare programs under the Social Security Act, including privately run Medicare Advantage (MA) and Part D drug plans, Wyden (D-Ore.) sent letters requesting more information from 15 state insurance commissioners and state health insurance assistance programs.

The letter—sent to officials in Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Oregon, Pennsylvania, and Texas—comes amid a surge in complaints about MA and Part D marketing materials that purport to inform seniors of their coverage options.

In May, the Centers for Medicare & Medicaid Services (CMS), which has the authority to regulate materials used to market MA and Part D plans, reported that complaints from seniors more than doubled from 2020 to 2021.

The most recent survey of state insurance commissioners conducted by the National Association of Insurance Commissioners, moreover, found that there has been an increase in complaints regarding "false and misleading advertising" of MA plans, wrote Wyden.

"Unfortunately, false or misleading advertisements and fraudulent sales practices are not new issues for Medicare beneficiaries," he continued. The lawmaker pointed to 2009 and 2010 reports from the Government Accountability Office and the Health and Human Services Office of Inspector General, respectively, which documented widespread grievances against private enterprises and sales agents over their peddling of MA plans.

"Given this trend in complaints," Wyden wrote, "I am seeking to better understand the nature and extent of these marketing and enrollment issues. Your offices of state insurance regulation and State Health Insurance Programs (SHIPs) are working on-the-ground and are uniquely positioned to hear directly from Medicare beneficiaries about false or misleading marketing and sales practices in MA and Part D."

To that end, Wyden asked the officials to provide joint or separate responses to a series of questions by September 16.

Among other things, Wyden wants officials to provide data on the number of complaints about MA and/or Part D marketing materials they have received in 2019, 2020, 2021, and 2022, including possible patterns of discrimination, as well as "examples of potentially false or misleading marketing materials and advertisements in MA or Part D, including mailers, robo-calls, websites, television commercials, and online advertisements."

Of Medicare's 60 million beneficiaries, nearly half are enrolled in MA plans and 50 million are enrolled in Part D plans. Corporations that manage MA plans have come under fire for upcoding, or exaggerating patients' illnesses in order to reap larger payments from the federal government—something they do while refusing to provide necessary care for tens of thousands each year.

Despite mounting evidence of rampant fraud and other abuses committed by private MA organizations, the Biden administration announced in April that MA insurers will receive one of the largest payment increases in the program's history in 2023, eliciting pushback from several congressional Democrats led by Rep. Katie Porter of California.

MA and Part D, progressives argue, are part of a broader effort to privatize Medicare and must be resisted.

Another major culprit is ACO REACH, a pilot program that critics have described as "Medicare Advantage on steroids."

The pilot—an updated version of Direct Contracting launched by the Trump administration and continued by the Biden administration—invites MA insurers and Wall Street firms to "manage" care for Medicare beneficiaries and allows the profit-maximizing middlemen to pocket as much as 40% of what they don't spend on patients, all but ensuring life-threatening cost-cutting.

Physicians and healthcare advocates have warned that a failure to stop ACO REACH could result in the complete privatization of traditional Medicare in a matter of years.

"Even though Medicare is relied on by millions of seniors across the country, and precisely because it is so necessary and cost-effective, it is under threat today from the constant efforts of private insurance companies and for-profit investors who want to privatize it and turn it into yet another shameful opportunity to make money off of peoples' health problems," Rep. Pramila Jayapal (D-Wash.) said in May.

Jayapal, the chair of the Congressional Progressive Caucus and lead sponsor of the Medicare for All Act in the House, has called on the Biden administration to "fully end" ACO REACH and other privatization schemes.

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

We've had enough. The 1% own and operate the corporate media. They are doing everything they can to defend the status quo, squash dissent and protect the wealthy and the powerful. The Common Dreams media model is different. We cover the news that matters to the 99%. Our mission? To inform. To inspire. To ignite change for the common good. How? Nonprofit. Independent. Reader-supported. Free to read. Free to republish. Free to share. With no advertising. No paywalls. No selling of your data. Thousands of small donations fund our newsroom and allow us to continue publishing. Can you chip in? We can't do it without you. Thank you.

Calls for SCOTUS Ethics Probe Grow as Court Lawyer Defends Alito

"Supreme Court justices have avoided accountability for too long," said one critic. "It's time for our elected officials to do their job, and serve as a true check on the judiciary."

Julia Conley ·

From Floods to Droughts, Every Region of the World Suffered Water Extremes Last Year: UN

The head of the World Meteorological Organization said 2021's water extremes stemmed from "the impacts of climate change."

Jake Johnson ·

Puerto Rican Towns File RICO Suit Accusing Big Oil of Colluding on Climate Denial

Sixteen municipalities are trying to force Chevron, ExxonMobil, Shell, and others to pay for damages from the 2017 hurricane season, which was exacerbated by planet-heating fossil fuel emissions.

Kenny Stancil ·

'All of Rail Labor Is Going to Suffer': Workers Furious Over Biden Move to Preempt Strike

"This is a legacy-defining moment for Joe Biden," said Railroad Workers United. "He is going down as one of the biggest disappointments in labor history."

Jake Johnson ·

Citing Need for 'New, Inclusive Leadership,' Chuy García Files for Chicago Mayoral Race

"We have an opportunity to elect a trusted and experienced leader with a history of building coalitions and a vision for a brighter future for all Chicagoans," said the Democratic congressman.

Jessica Corbett ·

Common Dreams Logo