As the manager of a union benefit plan - self insured - we do have a program of intensive bill review as well as normal claims processing reviews - we do see some "upcoding", too - perhaps not to the degree that CMS does for Medicare or states do for Medicaid. We see significant "unbundling" by many hospitals/health systems - where they bill for services that should be part of the bundled charge. We suggest that the DOJ should look at that, too.
I don't trust anything this DOJ does. Yes, no doubt there are ongoing shenanigans by UHC and the like... but I don't trust this DOJ not to use this situation as a way that could eventually limit, restrict, or outright deny REAL serious, undiagnosed medical issues and their necessary interventions.
Part C plans ( i.e. Medicare Advantage) should be illegal. They are privately owned companies that serve as medicare health insurers. Because they have no responsibilities to anyone but themselves, they frequently deny claims that they legally should pay and you get stuck with a huge amount of money out of pocket for your cancer operation. In today’s Times, there is an article telling how one insurer called the doctor when he was in surgery with a patient, and she is open on the table, saying they won’t pay her claim. What is supposed to happen now? She goes into bankruptcy?
This is fraud and illegal and the government does zero to help. Never choose Plan C no matter what they promise you. Smart people know the truth. It starts out cheaper than regular medicare and then, when they deny your claim, it will be the most costly insurance you will ever have.
Disgusting. I hate all the senators and congressmen— they do nothing all day but take full benefits( healthcare better than yours) and salary( possibly more than yours). These people ARE the fraud and abuse in Washington!!!!.
Help me LOL yesterday I received an email from my private for-profit health insurance inviting me to invest in my health and join Wellabe rewards program. Of course this was after they raised my monthly premium.
We deserve healthcare free of all middlemen & therefore free of all profit.
As the manager of a union benefit plan - self insured - we do have a program of intensive bill review as well as normal claims processing reviews - we do see some "upcoding", too - perhaps not to the degree that CMS does for Medicare or states do for Medicaid. We see significant "unbundling" by many hospitals/health systems - where they bill for services that should be part of the bundled charge. We suggest that the DOJ should look at that, too.
I don't trust anything this DOJ does. Yes, no doubt there are ongoing shenanigans by UHC and the like... but I don't trust this DOJ not to use this situation as a way that could eventually limit, restrict, or outright deny REAL serious, undiagnosed medical issues and their necessary interventions.
I agree.... since our founding it's been mostly about ensuring the wealthholders do well no matter what it takes.
Grand theft of wage wealth from the lower / middle class.
Upcoding and incentives to doctors for keeping down the costs to
insure Healthcare remains the #3 sector on Wall Street. Market Cap is still $7.2 Trilllion.
We need the DOJ to investigate the ACO REACH program on how much doctors' bonuses are who participate with patients in Traditional Medicare.
Profit first, Care maybe?!?!?!
Part C plans aka private-for profit insurance companies get a corporate welfare raise in 2026 to the tune of 5.06%
Part C plans ( i.e. Medicare Advantage) should be illegal. They are privately owned companies that serve as medicare health insurers. Because they have no responsibilities to anyone but themselves, they frequently deny claims that they legally should pay and you get stuck with a huge amount of money out of pocket for your cancer operation. In today’s Times, there is an article telling how one insurer called the doctor when he was in surgery with a patient, and she is open on the table, saying they won’t pay her claim. What is supposed to happen now? She goes into bankruptcy?
This is fraud and illegal and the government does zero to help. Never choose Plan C no matter what they promise you. Smart people know the truth. It starts out cheaper than regular medicare and then, when they deny your claim, it will be the most costly insurance you will ever have.
Disgusting. I hate all the senators and congressmen— they do nothing all day but take full benefits( healthcare better than yours) and salary( possibly more than yours). These people ARE the fraud and abuse in Washington!!!!.
I agree and the deceitful agents and brokers will claim their services are free.
Wendell thanks for helping.
Help me LOL yesterday I received an email from my private for-profit health insurance inviting me to invest in my health and join Wellabe rewards program. Of course this was after they raised my monthly premium.
We deserve healthcare free of all middlemen & therefore free of all profit.
This has been going on for decades! Ask Rick Scott and WellCare! And it is our tax dollars!
Here's the consequence of Medicare Advantage thievery: https://www.thestreet.com/retirement/retired-workers-to-see-shocking-change-to-medicare-in-2026?fbclid=IwQ0xDSwLbeRljbGNrAtt5EGV4dG4DYWVtAjExAAEe9QUqPTwdrOOmCZf4YOluHE01SrZNhe80wW7MBUscCZfzEZSkFrOLeXTzOOs_aem_pA1I850_bf-SxjzhjGkmJg
Each person on this thread can help the upcoding abuse.
Take a look at your diagnosis list and if we see something there that is not a problem, ask your primary to remove it and report it to Medicare.
I'm glad you like it!
I'm a volunteer SHIP counselor. and up til now, Traditional Medicare has been between the patient- provider and Medicare.
Now CMS is inserting a middleman to do prior authorization checks-not good!!