Becker's Healthcare October 10, 2022
Though Medicare Advantage was designed to help lower federal healthcare expenditures, payers have exploited the program through elaborate schemes that make patients appear sicker than they actually are — thereby leading to higher payments from CMS, according to an Oct. 8 report from The New York Times.
The Times analyzed dozens of fraud lawsuits against major payers, inspector general audits and watchdog investigations to show how insurers have abused the program to raise their profits by billions.
- Accused of fraud by a whistleblower: UnitedHealth Group, Humana, Kaiser Permanente, Cigna, SCAN Group
- Accused of fraud by federal government: UnitedHealth Group, Elevance Health, Cigna, SCAN Group
- OIG says it overbilled: UnitedHealth Group, Humana, CVS Health, Elevance Health, BCBS Michigan, Cigna, Highmark,...
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