Over the past year, a Wall Street Journal investigative team has pored through billions of records of services provided under Medicare; they have found that insurers got extra payments after finding diagnoses for a patient that no provider had treated, selectively recruited patients who used few Medicare services, and implemented policies to oust high-cost patients. (The records are not public; they were provided under a confidentiality agreement for the research.)
Medicare Advantage is a program whereby people eligible for Medicare pay premiums to a private insurer, which operates on those premiums and payments from Medicare.
The findings were reported as “How Health Insurers Racked Up Billions in Extra Payments from Medicare Advantage.”
