Medicare Advantage battle

Medicare is a gigantic entitlement program with Macroeconomic impact. We have discussed Medicare Advantage on METAR before.

Over half of Medicare benficiaries choose Medicare Advantage despite its problems of restricting reimbursement for larger medical expenditures. We have also discussed the evidence that the insurance companies that provide Medicare Advantage coverage sometimes deliberately deny reimbursement even when they are legally obligated to cover the expense, leaving the patients on the hook.

A separate issue is overpayments from the government to the insurance companies.

‘Everybody has blood on their hands’: A decade-long battle over Medicare Advantage audits is coming to a head

  • Bob Herman

By Bob Herman, Stat News, Jan. 30, 2023

The federal government and health insurance companies have been clashing for more than a decade over how Medicare Advantage plans should be audited and how the well-documented overpayments to those plans should be clawed back…

Billions of dollars are on the line, almost all of which would get redirected back toward taxpayers and Medicare enrollees. But that large amount of money is also the major reason why there has been so much inertia. On one side sits an insurance industry hellbent on ensuring nosy auditors don’t touch its extremely profitable Medicare Advantage plans. On the other side exists an under-resourced federal oversight system that has become paralyzed by its own indecision and deference to that politically powerful industry…[end quote]

Because of heavy advertising, enrollment in Medicare Advantage is growing.

I see this as a David-and-Goliath scenario where the government auditors are David and the insurance lawyers are Goliath. My money would be on the insurance companies (even though I deplore them).