Medicare Inc.: How Giant Insurers Make Billions Off Seniors
The Wall Street Journal’s investigative series “Medicare Inc.: How Giant Insurers Make Billions Off Seniors” exposed how private insurers exploit the Medicare Advantage system by prioritizing profits over actual patient care. The series, led by a team with extensive experience in analyzing Medicare data, revealed that insurers are financially incentivized to minimize services while increasing reported diagnoses to boost government payments. The investigation involved unprecedented access to Medicare data, covering every service provided to beneficiaries from 2015 to 2022. Through data analysis, interviews and internal corporate documents, the team discovered a disturbing pattern where insurers profited from diagnoses reported without providing corresponding treatment, including during home visits.
The Journal’s in-depth research, which included reverse-engineering Medicare’s payment algorithms, confronted numerous challenges, including learning complex statistical software and processing massive datasets. Their findings uncovered systemic issues, such as insurers exploiting home visit diagnoses to claim billions in inflated payments.
The impact of the investigation has been significant, prompting congressional inquiries and influencing federal policy. The Office of Inspector General recommended halting payments based solely on home visit diagnoses. The Congressional Budget Office estimated a potential $124 billion in savings over ten years if such payments were stopped. Additionally, federal investigations have been initiated, including by the Justice Department and Sen. Chuck Grassley, who cited the reports in demanding disclosures from UnitedHealth. The series has also galvanized further research, with institutions like the Kaiser Family Foundation expanding on the Journal’s findings about end-of-life care patterns. The Journal’s reporting is prompting legislative reforms and encouraging more accountability in Medicare Advantage practices.
Chart image courtesy of the Wall Street Journal.
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