How Insurers Exploited Medicare Advantage for Billions in Fraud: Insights from Abelson & Sanger-Kats Essay

Introduction

The article “‘The cash monster was insatiable’: How insurers exploited Medicare for billions” was published in The New York Times on October 8, 2022. The authors discuss how Medicare beneficiaries were supposed to get premium plans while the big insurers were accused of fraud (Abelson & Sanger-Kats, 2022). For instance, Kaiser Permanente asked doctors to add extra illnesses to patients’ cards. Other companies, like Elevance Health and UnitedHealth Group, lied to patients about their health conditions to earn extra bonuses from insurers (Abelson & Sanger-Kats, 2022). Such strategies enabled the federal government’s Medicare Advantage program to pay insurers more money.

Article Summary

The government pays Medicare Advantage insurers a predetermined sum for each person who signs up; the costs are greater for sicker people. According to lawsuits, insurers, among the biggest and wealthiest American businesses, have frequently created complex systems to make their customers appear as ill as possible without offering additional care (Abelson & Sanger-Kats, 2022). As a result, a program intended to assist in reducing healthcare costs has dramatically increased in cost above the existing government program it was meant to replace.

Such actions were detrimental to the American healthcare system and insurance industry for several reasons. Primarily, the stolen money could have been spent on developing healthcare facilities or treatments. In addition, patients spent more money on additional procedures and drugs. What is more, patients’ outcomes were lower due to the fraud. This resulted in a lowered public health level, a key indicator of national well-being.

Personal Opinion

To my mind, insurers’ actions are ethically wrong as they contradict the principles of honesty and integrity. Such deeds create a sense of distrust among insurers, which further leads to insecurities regarding doctors and their treatment methods. Medicare Advantage programs may restrict consumers’ choice of physicians and even demand that patients undergo extra procedures before receiving some pricey medical treatments.

Conclusion

In conclusion, this article was chosen because lately, there has been an increase in the amount of fraud in the insurance industry. The article is interesting in the sense that it provides insight into the strategies used by insurers to steal money. Finally, it is curious how the government plans to stop this activity and if the legislation will apply to the presented cases.

Definitions

1. Medicare is a government health insurance program for people 65 years of age or older and some people under 65 who have specific disabilities or diseases.
2. A beneficiary is someone or something that you formally name to receive benefits from your financial products. In terms of life insurance, the death benefit is what would be paid out if you passed away.
3. An insurance contract that guarantees payment of compensation has an insurer as a party. A legal person or organization that ensures the risk is known as an insurer, typically an insurance company.
4. When it comes to health insurance and prescription drug coverage, Medicare Advantage is a private company plan that Medicare has approved as an alternative to the original Medicare program.
5. Costs associated with providing healthcare include those associated with services, tools, materials, and medications.

Reference

Abelson, R., & Sanger-Kats, M. (2022). ‘The cash monster was insatiable’: How insurers exploited Medicare for billions. The New York Times. Web.