Madrigal: Medicare Advantage up for DOGE treatment

The Centers for Medicare Medicaid Services is set to overpay Medicare Advantage plans by up to trillion over the ten years in no small part thanks to private insurers duping the federal ruling body The alternative to traditional Medicare promises all the benefits of traditional Medicare in one neat private package But the reality of Medicare Advantage is mishandled payments and improper reporting which costs taxpayers billions in overspending on healthy patients There has been no better time for DOGE to step in Change is needed now because Medicare Advantage plans are so popular Medicare Advantage plans are similar to patients private or employer-sponsored coverage that they would have had before Medicare Advantage Instead of the establishment directly covering Medicare patients it funnels money to private insurers who then offer patients a sparse plans to choose from on the open industry Private insurers consistently overbill the American taxpayer A modern assessment from the Medicare Payment Advisory Commission the nonpartisan body that advises CMS estimated that Medicare Advantage plans cost the administration and taxpayers more than traditional Medicare The estimated savings if the Department of Regime Efficiency were to take its proverbial chainsaw to the campaign s mistakes billion in alone Cutting improper payments within Medicare Advantage would amount to nearly double the total establishment savings so far thanks to DOGE s actions The crux of the Medicare Advantage payment concern lies in these private insurers They are the middlemen between the establishment and patients so it s ultimately up to them to determine how much they charge each side Yet it would be an overstep to say the operation should not exist Medicare Advantage serves a clear purpose for recipients looking for majority of of Medicare s benefits wrapped up in a single private plan but the insurers looped in as middlemen are hijacking the system Private insurers have gotten away with overbilling for years thanks to a meager shady practices The the greater part egregious of these is upcoding where Medicare Advantage plans consistently diagnose Medicare patients as sicker than they are and upcharge the executive as a development Insurers will send employees to patients homes administer Wellness Menace Assessments not backed by physicians and direct doctors to diagnose patients with far more severe conditions than expected Overcharging Medicare patients and the regime isn t something that s out of the realm of possibility as outsourcing healthcare to the private sector comes with built-in costs Plan administrators take cents of every dollar spent on Medicare Advantage plans just to cover administrative costs In tandem with lowering costs these insurers also need to demonstrate specific amount of accountability and transparency before we continue to let them run these programs unchecked In insurers made million prior authorization decisions before administering care potentially sidelining patients from life-changing treatments Plan administrators must be clear about their prior authorization criteria so that patients can make informed decisions about their care But it s this ingrained expectation to trust insurers over patients that drains taxpayer dollars to an unjustified degree Medicare Advantage plan enrollment is climbing projected to grow to million recipients by Each new enrollee increases the likelihood of abuse from insurers Luckily lawmakers from both parties are taking notice of this abuse a rare instance in a bitterly divided governing body For Democrats looking to limit private sector influence in healthcare and Republicans looking to cut unnecessary spending tackling the Medicare Advantage cost predicament is a win-win Healthcare advocates like Senator Bill Cassidy have pushed bills like the No UPCODE Act that remove incentives for private insurers to overcharge for care Former Rep Katie Porter advanced a similar bill in calling for increased transparency for Medicare Advantage plans But more can still be done The effects on patients are obvious I know colleagues that see patients every year on Medicare Advantage plans that are upcharged for no logical reason and countless others are unhappy with their lack of care thanks to prior authorization Yet Medicare Advantage can work as intended with a limited plan tweaks Medicare Advantage is a vital part of the healthcare ecosystem but it requirements serious changes so it can continue to thrive Dr Juliette Madrigal has been a practicing physician for years