Becker's Healthcare December 11, 2025
Traditional Medicare could have saved $7 billion from 2019 to 2023 across four services had it mirrored Medicare Advantage’s utilization rates and fraud strategies, according to a December Berkeley Research Group report sponsored by Elevance Health.
Because MA plans are responsible for tracking spending across Medicare Parts A and B, these plans rely on certain protective measures, such as prior authorization or step therapy, fraud unit findings, coverage policies on intensity of services, and capitated rates for total cost of care in negotiated provider contracts. The HHS Office of Inspector General highlighted skin substitutes, catheters, genetic testing and off-the-shelf orthotic braces as particularly subject to fraud, waste and abuse.
Researchers found that traditional Medicare spent 1.5 to 6.5 times...
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