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medicare advantage
Rampant Medicare Advantage Fraud Is Staring Musk in the Face. Critics Predict He'll Ignore It
"I'll bet Elon and the DOGE boys can't find Medicare Advantage," quipped one economist. "You know these people were not hired on merit."
Feb 06, 2025
Privatized Medicare Advantage plans overbill the U.S. federal government by up to $140 billion per year as they make patients appear sicker than they actually are to rake in more taxpayer money.
It didn't take a team of inexperienced engineers combing through the complex and sensitive inner workings of government payment systems to reach that conclusion, but that's reportedly what Elon Musk's lieutenants are now doing at the Centers for Medicare and Medicaid Services (CMS) with the stated goal of locating and combatting "fraud."
On Wednesday, The Wall Street Journalreported that representatives of the so-called "Department of Government Efficiency" (DOGE) have gained "access to key payment and contracting systems" at CMS with an eye toward "pinpointing what they consider fraud or waste."
Precisely what Musk and his lackeys see as fraud, and whether pervasive Medicare Advantage overbilling fits their definition, is unclear. In a post to his social media platform on Wednesday, Musk claimed—without elaborating or providing any evidence—that CMS is "where the big money fraud is happening."
But critics expressed doubt that Medicare Advantage, a huge cash cow for private insurers that's supported by President Donald Trump and congressional Republicans, will become a focal point of Musk's austerity blitz.
"You don't have to search payment systems for Medicare fraud, you could turn to the latest published report from the Medicare Payment Advisory Commission which helpfully lists $83 billion in annual fraud payments," The American Prospect's David Dayen wrote Wednesday. "The unnecessary overpayments are all made to private insurers in Medicare Advantage, the privatization of Medicare. We found the money!"
"Alternatively, if you're hunting for Medicare fraud you could go to the office of Senator Rick Scott," Dayen added, referring to the Florida Republican whose healthcare firm committed large-scale Medicare and Medicaid fraud.
Last month, Dayen noted that a crackdown on Medicare Advantage is "an unlikely avenue for DOGE" given that Mehmet Oz—who campaigned for the U.S. Senate on a plan dubbed "Medicare Advantage for All"—is poised to lead CMS.
Nor has Robert F. Kennedy Jr., who is on track for Senate confirmation to lead the department that oversees CMS, expressed any interest in tackling Medicare Advantage fraud. During his confirmation hearing last week, Kennedy failed to correctly answer basic questions about Medicare, including Medicare Part C—also known as Medicare Advantage.
Dean Baker, a senior economist at the Center for Economic and Policy Research, quipped Thursday that "I'll bet Elon and the DOGE boys can't find Medicare Advantage."
"You know these people were not hired on merit," he added.
In a blog post on Wednesday, Baker pushed back on the view that "Musk and his crew somehow want a world without government," writing that in reality they simply "don't want government social programs that help people who are not rich."
"Musk's view is that the government should only be there to make him and his fellow billionaires richer," Baker wrote. "We could have a much more efficient insurance system if we had Medicare for All, but that would wipe out the private insurance industry. Instead, we are going the other way and whittling down traditional Medicare and increasing costs by pushing people back to private insurers with Medicare Advantage."
"It is absurd that people on the left have allowed the Musk billionaire libertarians of the world to pretend they are anti-government," Baker added. "They just want a government that only serves their interest rather than society as a whole."
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RFK Jr Refuses to Say Healthcare Is a Human Right at Confirmation Hearing
"The problem is that Kennedy isn't 'anti-establishment' in any way that would actually help working-class people at the expense of wealthy plutocrats."
Jan 29, 2025
Anti-vaccine activist Robert F. Kennedy Jr., President Donald Trump's nominee to direct federal health policy, faced the U.S. Senate Finance Committee on Wednesday having made a name for himself as a public figure bent on "making America healthy again"—pushing anti-scientific warnings against seed oils, falsely claiming as recently as 2023 that "autism comes from vaccines," and pledging to protect Americans from harmful toxins.
But Kennedy's confirmation hearing to be the secretary of health and human services presented the latest evidence that the environmental lawyer and former presidential candidate has little if any concern about how the health of the country is impacted by one significant factor: the fact that Americans rely on a for-profit industry—empowered to deny coverage for lifesaving treatment on a whim—in order to obtain healthcare.
In his opening statement to the committee, Kennedy signaled a lack of interest in discussions about the finances involved in the U.S. healthcare system—one in which the top five health insurers have reported more than $371 billion in profits since the Affordable Care Act was passed in 2010, while increasingly denying medical claims and charging families an average of $26,000 per year in premiums.
"I don't want to make this too much about money," said Kennedy, adding that "the nation has been locked in a divisive healthcare debate about who pays."
He dismissed debates about whether healthcare costs at the point of service should be paid by the government, corporations, providers, or families as "like rearranging deck chairs on the Titanic" and turned his attention to "chemical additives in our food supply" and "chronic disease."
Ahead of the hearing, political commentator Ben Burgis wrote at MSNBC that while Kennedy has sold himself to the public as an anti-establishment figure, unafraid of standing up to Big Pharma by spreading conspiracy theories about vaccines, "the problem is that Kennedy isn't 'anti-establishment' in any way that would actually help working-class people at the expense of wealthy plutocrats."
He has all but dismissed concerns about health insurers like UnitedHealthcare, which made $23 billion in profits last year and now reportedly denies 1 in 3 medical claims, including for cancer treatments in some cases.
"The profit motive is human nature," Kennedy said in an interview with the online news show Breaking Points in 2023.
The nominee said at the hearing that he has "often disturbed the status quo by asking uncomfortable questions," but in an exchange with Sen. Bill Cassidy (R-La.) about Medicare and Medicare Advantage, the privatized system into which right-wing policymakers aim to push more seniors, even as it denies patients necessary care, Kennedy made clear again that he doesn't aim to question the status quo regarding the for-profit system.
Americans "would prefer to be on private insurance," said Kennedy. "Most Americans, if they could afford to be, will be on private insurance."
The comment drew incredulous laughter from Sen. Bernie Sanders (I-Vt.), a longtime proponent of Medicare for All, according to reports.
Kennedy didn't cite any sources for his claim. A Gallup poll last month found that 62% of U.S. adults—the highest percentage in a decade—believe the government should guarantee that all Americans have health coverage. The survey was released days after the killing of UnitedHealthcare CEO Brian Thompson, an event that sparked a nationwide discussion over the for-profit healthcare industry's claim-denial practices and exorbitant out-of-pocket costs for patients, which have proven deadly for some and have pushed millions of Americans into medical debt.
Later, Sanders pointed to the $70 billion the insurance industry raked in last year as 85 million Americans remained uninsured or underinsured and asked whether Kennedy agrees that the U.S. "should join every other major country on Earth and guarantee healthcare as a human right."
Kennedy replied that healthcare should not be treated as a human right as free speech is, because "in healthcare, if you smoke cigarettes for 20 years and you get cancer, you are now taking from the pool."
Annabelle Gurwitch, an author and activist, said Kennedy's response pointed to a worldview that is "dangerous to our health."
"So now we are going to determine care based on a metric that measures perceived responsibility: We'll need to police eating habits, drinking habits, and perhaps genetics and doling out care based on that," said Gurwitch, urging senators to "vote no on Kennedy."
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Trump Reportedly Picks Medicare Advantage Lobbyist for Top Health Budget Role
Don Dempsey would join Centers for Medicare and Medicaid Services nominee Mehmet Oz and other supporters of privatized Medicare Advantage plans in the new administration.
Jan 23, 2025
U.S. President Donald Trump is reportedly set to appoint a lobbyist for the for-profit health insurance industry for a top White House budget job, a move likely to heighten concerns about the new administration's expected push to bolster Medicare Advantage plans that deny necessary care and dramatically overbill the federal government.
The Financial Timesreported Wednesday that Trump is "poised to appoint" Don Dempsey as associate director of the Office of Management and Budget's health programs. The appointment would give Dempsey "sweeping power over the $1.8 trillion U.S. healthcare budget and responsibilities of the 13 divisions and agencies," the newspaper noted.
Dempsey is currently the vice president of policy and research at the Better Medicare Alliance, a lobbying organization that describes itself as "the nation's leading research and advocacy organization supporting Medicare Advantage." FT observed that the group is "funded by insurance companies including UnitedHealth Group and Humana"—the two largest Medicare Advantage insurers in the United States.
Trump's reported choice represents another potential boon for Medicare Advantage, a program run by private insurers and funded by the federal government. As STATreported last month, "Medicare Advantage insurers thrived under the first Trump administration, and it's expected to happen again now that Trump is returning to the White House and Republicans are taking control of Congress."
The president has nominated Mehmet Oz, who has previously expressed support for a plan dubbed "Medicare Advantage for All," to lead the Centers for Medicare and Medicaid Services (CMS), a move that one watchdog warned would kick Medicare privatization efforts "into overdrive."
Since his inauguration earlier this week, Trump has taken a number of steps that have alarmed healthcare advocates, including rescinding Biden-era executive orders aimed at lowering prescription drug prices and strengthening Medicaid and the Affordable Care Act.
"On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes," Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, toldKFF Health News. "But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid."
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