Are you at risk? Representative reveals how UnitedHealthcare might be taking advantage of Medicare
- Replies 4
Healthcare should provide security, especially for seniors in their golden years.
However, questions are emerging about whether the system meant to safeguard them is truly serving its purpose.
Concerns have been growing over how major insurance companies manage Medicare Advantage plans—specifically, whether certain practices benefit insurers more than the patients they are meant to serve.
At the heart of this debate is one of the industry’s largest players, UnitedHealthcare.
Medicare Advantage, the private alternative to traditional Medicare, has drawn millions of Americans with its lower premiums and additional benefits like vision and dental coverage.
By 2022, more than 32 million people—nearly half of all Medicare-eligible individuals—had enrolled in these plans.
Recently, UnitedHealthcare has faced increased attention following the tragic death of its CEO, Brian Thompson, in New York City.
At the same time, concerns over claim denials have sparked broader discussions about insurer practices and the Medicare Advantage system.
With ongoing scrutiny, many are now asking: Is the system functioning as intended, or are there areas that need reform?
Concerns over Medicare and Medicaid spending have reached Congress, with North Carolina Representative Greg Murphy voicing strong opinions on the issue.
He accused UnitedHealthcare of overcharging and inflating patient risk profiles to receive higher Medicare payments—something known as "upcoding."
Murphy criticized UnitedHealthcare, stating, "I'll pick out the worst offender is United which is literally charging $1,000 more per enrollee than anyone else and they upcode them."
In an interview with Maria Bartiromo, he explained, "You take a stone-cold healthy person and they suddenly have 15 things wrong with them, then on the backside, they don't pay the people they should."
Murphy criticized these insurer practices, calling them a "scam."
"It's not necessarily fraud because some of this is legal, but they're pushing the boundaries, and it's really immoral in fact," he said.
Murphy’s statements have fueled bipartisan support for Medicare reform, with lawmakers on both sides calling for greater oversight.
As scrutiny increases, questions remain about whether insurance companies are prioritizing profits over patient care.
Meanwhile, a UnitedHealthcare spokesperson defended Medicare Advantage, telling Newsweek, "Medicare Advantage is highly popular with seniors due to the quality, access and affordability of care delivered and additional supplemental benefits—all while being more affordable for patients and reducing costs for the broader health system."
Some lawmakers and healthcare leaders have raised concerns about private insurers potentially inflating diagnoses to charge the government for conditions patients don’t have.
UnitedHealthcare claims Medicare Advantage members pay 45% less than those on Medicare Fee-for-Service (FFS), saving about $2,500 annually.
A 2024 Milliman analysis also found that Medicare Advantage saves the federal government 4%—over $20 billion per year—compared to FFS plans.
Meanwhile, Special Master Suzanne Segal recently recommended dismissing a decade-long DOJ case against UnitedHealthcare, stating there was no evidence the company was overpaid.
A past lawsuit also claimed UnitedHealthcare used Artifical Intelligence (AI) to deny Medicare Advantage coverage to some elderly patients, despite knowing the algorithm had a 90% error rate.
In a December 13 press release, UnitedHealthcare pushed back against these allegations, stating: "UnitedHealthcare approves and pays about 90 percent of medical claims upon submission. Importantly, of those that require further review, around one-half of one percent are due to medical or clinical reasons. Highly inaccurate and grossly misleading information has been circulated about our company's treatment of insurance claims."
However, experts like Chris Fong, CEO of Smile Insurance Group, and Michael Ryan, founder of MichaelRyanMoney.com, argue that the system still leaves room for potential abuse.
Alex Beene told Newsweek that Medicare Advantage was meant to enhance benefits but has become costlier for both the government and patients, with companies like UnitedHealthcare accused of "upcharging" bills.
They worry that some insurers may be taking advantage of Medicare's payment structure at the expense of both patients and taxpayers.
At The GrayVine, we believe that staying informed is essential to making well-informed healthcare decisions.
As the debate over Medicare Advantage and insurer practices continues, the outcome could significantly affect both the cost and quality of coverage for millions of seniors.
Read next: Doctor exposes how an insurance giant questions life-saving procedures
Have you experienced issues with your Medicare Advantage plan? Do you have concerns about how insurers are handling claims and coverage? Share your thoughts in the comments below.
However, questions are emerging about whether the system meant to safeguard them is truly serving its purpose.
Concerns have been growing over how major insurance companies manage Medicare Advantage plans—specifically, whether certain practices benefit insurers more than the patients they are meant to serve.
At the heart of this debate is one of the industry’s largest players, UnitedHealthcare.
Rising concerns: UnitedHealthcare faces scrutiny over its Medicare Advantage practices and their impact on seniors. Image Source: YouTube / NewsNation.
Understanding the controversy
Medicare Advantage, the private alternative to traditional Medicare, has drawn millions of Americans with its lower premiums and additional benefits like vision and dental coverage.
By 2022, more than 32 million people—nearly half of all Medicare-eligible individuals—had enrolled in these plans.
Recently, UnitedHealthcare has faced increased attention following the tragic death of its CEO, Brian Thompson, in New York City.
At the same time, concerns over claim denials have sparked broader discussions about insurer practices and the Medicare Advantage system.
With ongoing scrutiny, many are now asking: Is the system functioning as intended, or are there areas that need reform?
The allegations unfold
Concerns over Medicare and Medicaid spending have reached Congress, with North Carolina Representative Greg Murphy voicing strong opinions on the issue.
He accused UnitedHealthcare of overcharging and inflating patient risk profiles to receive higher Medicare payments—something known as "upcoding."
Murphy criticized UnitedHealthcare, stating, "I'll pick out the worst offender is United which is literally charging $1,000 more per enrollee than anyone else and they upcode them."
In an interview with Maria Bartiromo, he explained, "You take a stone-cold healthy person and they suddenly have 15 things wrong with them, then on the backside, they don't pay the people they should."
Also read: Luigi Mangione named key suspect in UnitedHealthcare CEO murder
Murphy criticized these insurer practices, calling them a "scam."
"It's not necessarily fraud because some of this is legal, but they're pushing the boundaries, and it's really immoral in fact," he said.
Murphy’s statements have fueled bipartisan support for Medicare reform, with lawmakers on both sides calling for greater oversight.
As scrutiny increases, questions remain about whether insurance companies are prioritizing profits over patient care.
Meanwhile, a UnitedHealthcare spokesperson defended Medicare Advantage, telling Newsweek, "Medicare Advantage is highly popular with seniors due to the quality, access and affordability of care delivered and additional supplemental benefits—all while being more affordable for patients and reducing costs for the broader health system."
Also read: Is your medicare advantage coverage at risk? See how millions are losing theirs!
The data and legal landscape
Some lawmakers and healthcare leaders have raised concerns about private insurers potentially inflating diagnoses to charge the government for conditions patients don’t have.
UnitedHealthcare claims Medicare Advantage members pay 45% less than those on Medicare Fee-for-Service (FFS), saving about $2,500 annually.
A 2024 Milliman analysis also found that Medicare Advantage saves the federal government 4%—over $20 billion per year—compared to FFS plans.
Meanwhile, Special Master Suzanne Segal recently recommended dismissing a decade-long DOJ case against UnitedHealthcare, stating there was no evidence the company was overpaid.
A past lawsuit also claimed UnitedHealthcare used Artifical Intelligence (AI) to deny Medicare Advantage coverage to some elderly patients, despite knowing the algorithm had a 90% error rate.
Also read: Retirees: 3 key Medicare Advantage pitfalls to be aware of
The defense
In a December 13 press release, UnitedHealthcare pushed back against these allegations, stating: "UnitedHealthcare approves and pays about 90 percent of medical claims upon submission. Importantly, of those that require further review, around one-half of one percent are due to medical or clinical reasons. Highly inaccurate and grossly misleading information has been circulated about our company's treatment of insurance claims."
However, experts like Chris Fong, CEO of Smile Insurance Group, and Michael Ryan, founder of MichaelRyanMoney.com, argue that the system still leaves room for potential abuse.
Alex Beene told Newsweek that Medicare Advantage was meant to enhance benefits but has become costlier for both the government and patients, with companies like UnitedHealthcare accused of "upcharging" bills.
They worry that some insurers may be taking advantage of Medicare's payment structure at the expense of both patients and taxpayers.
At The GrayVine, we believe that staying informed is essential to making well-informed healthcare decisions.
As the debate over Medicare Advantage and insurer practices continues, the outcome could significantly affect both the cost and quality of coverage for millions of seniors.
Read next: Doctor exposes how an insurance giant questions life-saving procedures
Have you experienced issues with your Medicare Advantage plan? Do you have concerns about how insurers are handling claims and coverage? Share your thoughts in the comments below.
