Republicans have discovered $124 billion in wasteful Medicare spending that enriches insurance coverage corporations on the expense of seniors and taxpayers. The one query is that if they’ll take the financial savings or concede the insurance coverage foyer’s declare that every one efforts to rein in waste, fraud and abuse are “Medicare cuts.”
This alternative will outline Republican credibility on authorities waste for years to come back. The chance is concrete and bipartisan.
The No UPCODE Act, launched by Sen. Invoice Cassidy, R-La., and Sen. Jeff Merkley, D-Ore., would immediately assault Medicare overbilling. It ensures that sufferers are identified by docs, not insurance coverage corporations trying to maximize funds.
Right here’s how the fraud works: Medicare pays insurers extra when sufferers seem sicker on paper. Insurers reply by including diagnoses that docs by no means made to get larger authorities funds.
UnitedHealthcare, the nation’s largest Medicare Benefit insurer, is beneath federal investigation for this. The Congressional Price range Workplace estimates that stopping it could save taxpayers $124 billion over the subsequent decade.
Cassidy, a doctor, frames the stakes clearly: “The Medicare Belief Fund goes bust in eight years.”
For anybody involved about fiscal accountability, this needs to be easy. President Trump has repeatedly referred to as for eliminating Medicare waste, but the invoice has stalled in Congress. Insurance coverage corporations have mobilized an intense lobbying marketing campaign to cease it.
UnitedHealthcare doubled its Washington spending to $7.7 million within the first half of 2025. Its technique is to reframe anti-fraud measures as “Medicare cuts” to intimidate Congress into inaction.
In actuality, stopping fraud signifies that extra funds are allotted to affected person care slightly than insurance coverage firm earnings. A number of key Republicans acknowledge this chance.
Senate Finance Chairman Mike Crapo, R-Idaho, helps the invoice, joined by GOP colleagues Roger Marshall of Kansas and Mike Rounds of South Dakota. Mehmet Oz, now main the Facilities for Medicare and Medicaid Providers, has introduced expanded auditing to “crush fraud, waste and abuse.”
But, Republicans know insurance coverage corporations will spend hundreds of thousands portraying any motion as an assault on seniors. This playbook has protected wasteful spending for many years.
The stakes are excessive for Republicans who marketing campaign on fiscal accountability. Sen. Rand Paul, R-Ky., not too long ago lamented that Republicans “as soon as knew how one can repair the deficit” however at the moment are “shedding the battle.”
When each events agree that spending is an issue, apparent options shouldn’t be ignored. Medicare beneficiaries acquire nothing from overbilling schemes besides larger premiums and weakened program solvency.
The insurance coverage business’s fierce resistance exposes what’s at stake — defending billions in unearned earnings. Eliminating overbilling would drive insurers to compete on effectivity and high quality of care slightly than gaming fee formulation.
Mark Merritt is a well being coverage knowledgeable who has labored at a number of well being organizations/InsideSources
