Are Medicare Advantage Health Plans Committing Fraud?

For Immediate Release
November 6, 2018 

With Enrollment Open for Medicare, CCHF Warns That Medicare Advantage Plans Deny Rightful Care and Payments, Increasing Health Plan Profits

ST. PAUL, Minn.—The open enrollment period for the Affordable Care Act is now in full swing, but few may realize that Medicare is in an open enrollment period of its own.

Citizens’ Council for Health Freedom (CCHF) wants to share a few facts with every American eligible for Medicare before they sign up for plans. For instance, original Medicare allows patients to go anywhere for services and treatment, but Medicare Advantage is the HMO version that limits enrollees to their networks.

“Are Medicare Advantage health plans committing fraud?” asked Twila Brase, president and co-founder of CCHF. “Medicare Advantage plans are paid a set amount of money each year per enrollee by the federal government regardless of medical care received. In September, the Office of Inspector General for the U.S. Department of Health and Human Services released a troubling report on these plans. Medicare Advantage plans regularly deny care or payment for care, but they overturn 75 percent of their own denials if the denial is appealed. However, just 1 percent of denials were appealed—perhaps because appeals are time- consuming. Our concern is that rightful payments and necessary medical services are being denied, perhaps to increase health plan profits at the patient’s expense. Do Medicare contracts with health plans allow them to act this way or is this fraudulent activity?”

If “Medicare for All” became law, Brase expects it would run as if it were “Medicare Advantage for All.” Similarly, despite the talk of this single-payer system, investors don’t appear worried perhaps because they too suspect it would be run by these highly profitable health plans. Case in point: Shares of UnitedHealth Group have gained nearly 1,400 percent and WellCare Health Plan stocks are up 4,000 percent since the inception

of Obamacare, which put health plans in control of the entire market.

Besides discussing a deteriorating Medicare system and the secret placement of senior citizens into the ACA’s Accountable Care Organizations (ACOs), another version of managed care, Brase’s new book, “Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records,” also exposes how and why Congress forced doctors and hospitals to install a data-collecting, command-and-control surveillance system in the exam room. Published this summer by Beaver’s Pond Press, “Big Brother in the Exam Room,” already in its second printing after hundreds of backorders were logged, discusses the negative impact of EHRs on

privacy, personalized care, costs, patient safety and more, according to doctors and data from more than 125 studies. Learn more at www.BigBrotherInTheExamRoom.com.

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To interview Twila Brase of Citizens’ Council for Health Freedom or for a review copy of “Big Brother in the Exam Room,” contact Deborah Hamilton, Media@HamiltonStrategies.com or 610.584.1096, ext. 102, or Patrick Benner, ext. 104.