Wyden

U.S. Sen. Ron Wyden (D-Ore.) speaks during a February 8, 2022 hearing on Capitol Hill in Washington, D.C. (Photo: Drew Angerer/Getty Images)

Senate Report Details 'Latest Privatized Medicare Scandal' as Seniors Preyed Upon and Duped

"It is unacceptable for this magnitude of fraudsters and scam artists to be running amok in Medicare," said Sen. Ron Wyden.

Insurance companies and other brokers are making false or misleading claims to dupe senior citizens into purchasing Medicare Advantage plans, according to a report published Thursday by the U.S. Senate Finance Committee.

"When a middleman makes profits from 'managing' your healthcare, they inevitably do so by limiting the care you get."

The report, which comes midway through this year's Medicare enrollment period--described last year by healthcare writer Susan Jaffe as "open season for scammers"--reveals that the number of Medicare beneficiary complaints about dubious private sector marketing tactics more than doubled from 2020 to 2021.

"Older Americans and those living with a disability count on Medicare to deliver dependable and high-quality healthcare when they need it most. It is unacceptable for this magnitude of fraudsters and scam artists to be running amok in Medicare," Senate Finance Committee Chair Ron Wyden (D-Ore.) said in a statement.

"Medicare Advantage offers valuable plan options and extra benefits to many seniors but it is critical to stop any tactics or actors that harm seniors or undermine their confidence in the program," he added.

Medicare Advantage, also known as Medicare Part C, was initially introduced as a private-sector alternative to the government-run program. Designed to provide innovative care alternatives at a lower cost than Medicare, Medicare Advantage plans pay third parties--usually insurance companies--monthly per-person fees to manage patient healthcare. In traditional Medicare, the government pays healthcare providers directly.

Around half of all Medicare beneficiaries are now enrolled in Medicare Advantage plans. The new Senate report exposes tactics used by unscrupulous insurance companies, brokers, and other third parties to pressure seniors to purchase plans, "including deceptive mail advertisements, misleading claims about increasing Social Security benefits, aggressive in-person marketing tactics, and enrolling beneficiaries... without their consent."

In August, the Senate Finance Committee collected Medicare Advantage marketing complaints from 14 states and found evidence that "beneficiaries are being inundated with aggressive marketing tactics as well as false and misleading information," with examples including:

  • Seniors shopping at their local grocery store are approached by insurance agents and asked to switch their Medicare coverage or Medicare Advantage plan.
  • Insurance agents selling new Medicare Advantage plans tell seniors that their doctors are covered by the new plans. Seniors who switch plans find out months later that their doctor is actually out-of-network, and they have to pay out-of-pocket to visit their doctor.
  • Seniors receive mailers that look like official business from a federal agency, yet the mailer is a marketing prompt from a Medicare Advantage plan or its agent or broker.
  • An insurance agent calls seniors 20 times a day, attempting to convince them to switch their Medicare coverage.
  • Widespread television advertisements with celebrities claim that seniors are missing out on benefits, including higher Social Security payments, in order to prompt seniors to call Medicare Advantage plan agent or broker hotlines.

Dr. Jessica Schorr Saxe, a retired family physician, noted in a recent Charlotte Observeropinion piece that "earlier this year, the federal government reported that 13% of denials in Medicare Advantage would not have been refused under traditional Medicare," while "Medicare Advantage plans are also increasingly ending nursing home and rehabilitation care before providers consider patients ready to go home."

Schorr Saxe continued:

So instead of innovating care, Medicare Advantage seems to mainly withhold it. It has also proven to be costly. Because such plans get higher government payouts for sicker patients, insurers have an incentive to exaggerate the sickness of enrollees.

According to federal audits, 8 of 10 of the largest companies have submitted inflated bills, and 4 of 5 of the very largest have faced federal lawsuits accusing them of fraud. In 2020 alone, these exaggerated risk scores generated $12 billion in excess payments. Because of this and other factors, the government actually spends 4% more for Medicare Advantage enrollees than those in traditional Medicare.

"Surely this program should be called Medicare Disadvantage," Schorr Saxe asserted. "When a middleman makes profits from 'managing' your healthcare, they inevitably do so by limiting the care you get."

"Medicare recipients, beware," she added. "And as citizens and taxpayers, we should all demand that Congress take Medicare out of the hands of corporations, freeing billions of dollars in savings to deliver actual healthcare."

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