[ceejayoz]

Small potatoes.

https://www.axios.com/2023/06/14/medicare-advantage-overpaym...

> Overpayments to insurers administering Medicare Advantage plans now exceed $75 billion a year due to aggressive coding of patients' health conditions and easily-achieved bonus payments tied to quality, researchers with the USC Schaeffer Center for Health Policy & Economics found.

[lotsofpulp]

Insurers are not the ones coding, it is the healthcare providers. And the government is the one deciding to pay.

If anything, that would mean more claims should be denied.

Looking at the study, it seems like the government made some erroneous assumptions about who would be taking advantage of the policies the government created, resulting in the extra costs. (Third paragraph of “policy context” section).

https://healthpolicy.usc.edu/research/ma-enrolls-lower-spend...

[ceejayoz]

Nope. https://www.nytimes.com/2022/10/08/upshot/medicare-advantage...

> Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

> Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

> Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.

[lotsofpulp]

That is just clear fraud, and I don’t understand how that is a lawsuit instead of felony charges for everyone involved.