News Release

Medicare Advantage Overpayment Tops $100 Billion


Physicians for a National Health Program has published a summary of Medicare Advantage (M.A.) overpayments, showing that M.A. results in a “$100 billion annual payoff for attracting inexpensive enrollees, upcoding disease severity, and biased price-setting procedures.” The report finds that M.A. has overcharged taxpayers “by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion.” Eliminating these overcharges in M.A. could fund either Part B premiums or overall federal spending on Part D drug benefits alone. Upcoding, the authors noted, accounted for “close to 5% of total payments.” 

    Kahn is a professor of health policy at the University of California at San Francisco and an editor and blogger at Health Justice Monitor

For Health Justice Monitor, Kahn added: “Tracking how Medicare Advantage games the Medicare payment system isn’t easy––there are multiple components, with considerable technical complexity.” But this new article assembles the data in an “easy-to-understand and well-cited review” to show that “M.A. plans are grabbing huge piles of money… from taxpayers and Medicare enrollees.” 

Kahn also includes a key to the article’s terminology.