Health Insurance Whistleblower: Medicare Advantage Is "Heist" by Private Firms to Defraud the Public

this is democracy now I'm Amy Goodman with Juan Gonzalez a major investigation by the New York Times this weekend has found many of the nation's largest health insurance companies have made billions of dollars in profits by exploiting the government's Medicare Advantage program eight of the ten largest Medicare Advantage providers have over billed the government six of the ten have been accused of fraud by the government or company whistleblowers this comes as the number of people enrolled in the privatized system continue to grow projections show that by next year more than half of all Medicare beneficiaries will be enrolled in a private plan under the system Health insurers get more Government funding for sicker patients which has given the companies an incentive to make patients appear more ill than they actually are United Health Humana Kaiser and other health insurance companies have been sued for fraud for over diagnosing patients to bump up profits the cost to taxpayers is staggering over billing by health insurance costs the government an estimated 12 to 25 billion dollars in 2020. the New York Times reports doctors at Kaiser were offered bottles of champagne and bonuses if they added additional illnesses to the medical records of their patients so the company could make more money joining us now is Wendell Potter former executive for the health insurance company Cigna and Humana Potter is now the president of the Center for Health and democracy and the president of Business Leaders for Health Care transformation he's author of the book deadly spin an insurance company Insider speaks out on how Corporate PR is killing health care and deceiving Americans welcome back to democracy Now Wendell joining us from Philadelphia if you can start off by explaining how Medicare Advantage Works many people might say oh they thought that was a government program for people 65 and older is is it's important to note that it is neither Medicare nor is it an advantage uh it is I think will be recognized and years to come as probably the biggest Heist the biggest fraud the biggest uh transfer of wealth from taxpayers middle income low-income Americans from them to corporate Executives and shareholders it is a plan that has been in the works or has been around for about 20 years it was uh born during the George W Bush Administration when Republicans control Congress and they were determined to start privatizing the Medicare program and as you noted uh now 20 years later is to the point that almost half and in some cities and districts uh well more than half already are enrolled in this program it is a private program it is operated by private insurance companies most of them are for-profit in fact this year over 80 percent of the enrollment in these plans uh were people enrolling in for-profit plans uh they're lured into these plans with deceptive advertising uh the plans feature things that are common in private plans but not in traditional Medicare such as prior authorization doctors have to get permission in many cases from uh the insurance company before they can treat their patients inadequate networks particularly as people get older and sicker and very very high out-of-pocket cost if if people knowingly or inadvertently go out of network so it is a a program that absolutely should be called disadvantage and Wendell Potter it's to me it's amazing the the Health Care system in this country right now when you go to a general practitioner they they basically are constantly referring you to Specialists who always then want to do more tests and it's the testing process of all of these Specialists that drive up these costs uh and as you say on television almost every single night there are ads trying to lure senior citizens uh into these Medicare Advantage uh programs it's privatization of Medicare why isn't the government exercising more regulation or control over these uh this process especially the one that at the Times reported piling on uh imagined or or or badly uh uh badly documented illnesses well it's not because Congress has never seen this kind of information before many governmental organizations and uh like the oig the GAO medpac which is which advises Congress on on Medicare issues and pavement issues and the Department of Justice which has intervened in a number of these whistle blower lawsuits against these companies uh that's been uh something that's been going on for a long time and they're also by the way have been other important journalists who've taken this on and done this investigation like Fred Schulte at the Kaiser health news Trudy Lieberman at the Center for Health journalism so they've known this but they've turned a Blind Eye in many cases because of the massive amounts of our money that these big corporations are spending to Lobby Congress to throw money into their campaigns for re-election and to uh into propaganda campaigns and very very misleading uh advertising as you just mentioned open enrollment will begin in just a few weeks for a Medicare eligible beneficiaries and you will see uh just a a barrage a constant barrage of ads from these companies that are they do not tell the truth they leave out important details like I some that I mentioned earlier so that's how they pull it off and Regulatory capture the center for Medicare and Medicaid services has been really asleep at the will they Congress actually has given CMS more authority to crack down on this fraudulent program but they've just turned a blind's eye that is a classic example of regulatory capture what right what is regulatory capture window what that means is that uh the uh companies the corporations that uh administer administrative uh offices like CMS the center for Medicare Services the health and Health and Human Services they have such influence over these uh these agencies uh that they don't act on behalf of of Americans they act on behalf of Corporations to protect their profits one of the administrators of CMS some years ago went straight from that job into the insurance industry as head of America's health insurance plans which is called ahip they also have staffed member former members of Congress have staffed front groups for the industry there's one called the better Medicare Alliance a former Pennsylvania congresswoman a Democrat was the first to head that up so that's how it happens there's this revolving door between Private Industry and government and massive again massive amounts of money that fund all this lobbying and and propaganda and Wendell Potter you had your own mother disenrolled from the Medicare Advantage plan over a decade ago why did that happen and what was the impact on her health as a result this is something that every senior should know they these companies go after people when they're younger and healthier with kind of a siren Call that you can enroll in these plans for no money you can actually get money put back into your Social Security account as we hear from people like Joe Namath and William Shatner and Jimmy J.J Walker but the truth is as you get older and sicker then you become aware of just the disadvantages of this program my mother broke her hip she needed to have rehab and skilled nursing services for a while when we looked at what was available to her in the provider Network it was incredibly inadequate so I worked with my mom to get her out of a Medicare Advantage plan it was one that was operated by United Healthcare and a market in conjunction with AARP which is an outrage in my view but uh she uh but but there's a problem there because when you do that and you're older uh and you wait you know years uh after being becoming eligible for Medicare uh it's harder and more expensive to get a Medicare supplement policy to help cover your out-of-pockets uh so we did that knowing that we had to pay a lot of money but at least she was able to get the care that she needed at a quality uh facility where she got the rehab and skilled nursing care that she needed which she would not have gotten had she stayed in that Medicare Advantage program I'm confident my mom lived additional years because of what we were able to do Wendell Potter finally what should Congress do to prevent this kind of Fraud and we're moving into the midterm elections There is almost no discussion of Medicare for all in the corporate media I don't know if it's because every five or six minutes they break for a commercial for some drug company for some new illness that has been defined but what has to happen right now well there are some important bills that have been introduced and some I trust will be introduced before too long congresswoman Katie Porter from California has introduced an important bill that would force the government uh enforce these plans to be more forthcoming more transparent to provide information and data that they're just withholding from from the government it should not even be called Medicare Advantage like I said earlier it's not Medicare nor is an advantage so I think there should be legislation that should bar these companies from even using the name Medicare there are some good members of Congress who understand this congresswoman Porter Congressman Mark pukan uh pramila jayapal Jan shakowski they're all aware of this and they unfortunately are the minority even among Democrats but I think that New York Times story and some of the other things that Advocates are beginning to do will wake them up and force them to get on the stick and do something uh congresswoman Jai Paul has been the lead sponsor as you may know of medic of Medicare for all Bill she gets it others get it too but this is going to be an important step along the way there's going to be a big frankly effort by industry to say we should have Medicare Advantage for all which would be the greatest travesty I think that this country could ever experience well no Potter want to thank you for being with us we'll link to that New York Times expose Wendell Potter is former executive for health insurance companies Cigna and Humana now serving as president of the Center for Health and democracy and the president of Business Leaders for Health Care transformation

Channel: Democracy Now!

Views: 460,282

Keywords: Democracy Now, Amy Goodman, News, Politics, democracynow, Independent Media, Breaking News, World News

Id: YEgNxlrfygI

Length: 11min 48sec (708 seconds)

Published: Wed Oct 12 2022