A group of Democratic lawmakers is urging Republicans to turn their attention toward Medicare Advantage to cut healthcare spending.
In a letter to Senate Majority Leader John Thune and House Speaker Mike Johnson, 36 members of Congress urged leaders to target upcoding by MA insurers.
“As Congress considers reconciliation legislation, we urge you to reject cuts to Medicaid, which
are deeply unpopular and will rip away health care from millions of Americans. Where there is widespread agreement is the need to address waste, fraud, and abuse by private, for-profit insurance companies,” the lawmakers, led by Sen. Elizabeth Warren, wrote.
Republican lawmakers are seeking up to $880 billion in savings from federal healthcare spending. Medicaid spending is expected to be the primary target of the cuts.
House Republicans dropped proposals to reduce federal assistance for Medicaid expansion states and implement per capita caps on Medicaid funding from reconciliation legislation, but work requirements and other policies are still on the table.
Nearly every major insurer has been accused of, or settled allegations of upcoding, the practice of making patients appear sicker than they are on paper to receive higher reimbursements from the government. In 2024, the Wall Street Journal published a series of reports on alleged upcoding in the program.
The Medicare Advantage Payment and Advisory Commission estimates that in 2025, the federal government will spend $84 billion more on MA enrollees than if they were enrolled in fee-for-service plans. Around half of this spending is linked to upcoding, according to MedPAC, which advises Congress on Medicare policy.
CMS Administrator Mehmet Oz, MD, has promised tougher scrutiny of the Medicare Advantage program.
Read the full letter here.
