The $500 Billion Medicare Overpayment Claim

5000亿美金的医疗保险超额支付索赔

Big Take

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2025-02-26

16 分钟
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More than half of Americans enrolled in Medicare receive their coverage from a private insurer through a program called Medicare Advantage. But according to whistleblowers, some of those companies may be overcharging the government and getting billions of taxpayer dollars in the process. Several Justice Department investigations have followed those claims. On today’s Big Take podcast, we hear from one of those whistleblowers and Bloomberg health-care reporter John Tozzi about how Medicare Advantage took off and the questions these fraud allegations raise about how taxpayer dollars are spent. Read more:  Major Insurers Are Scamming Billions from Medicare, Whistle-Blowers Say Medicare Advantage Fraud Case Settled for Up to $100 Million UnitedHealth Falls on DOJ Probe Into Medicare Billing See omnystudio.com/listener for privacy information.
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  • Bloomberg Audio Studios Podcasts Radio News if.

  • You qualify for Medicare, you might actually be covered by a private insurer.

  • Here's how that works.

  • Medicare Advantage is the US government's way of offering Americans who are 65 and older more options when it comes to health insurance.

  • People who opt into the program are covered by private insurers like UnitedHealth Group.

  • Those insurers get a monthly payment from the government to provide coverage for the people enrolled in their plans.

  • Today, more than half of the people enrolled in Medicare use a private Medicare Advantage plan.

  • But last week,

  • a source familiar with the matter told Bloomberg news

  • that the U.S. justice Department has a civil investigation into Medicare billing practices at UnitedHealth Group,

  • one of those participating private insurers.

  • The question at the center of that.

  • Investigation, which was first reported by the.

  • Wall Street Journal, is are insurers working the system to get higher payments from the government?

  • Companies invest a tremendous amount of time, effort, money,

  • resources into documenting the illnesses that their members have

  • because it means money coming in the door,

  • right?

  • That's Bloomberg Healthcare reporter John Tazi.

  • But the issue that has emerged is there's some ambiguity in the rules and in litigation in cases whistleblowers have brought to light.