February 25, 2025 • 16 mins
More than half of Americans enrolled in Medicare receive their coverage from a private insurer through a program called Medicare Advantage. But according to whistleblowers, some of those companies may be overcharging the government and getting billions of taxpayer dollars in the process. Several Justice Department investigations have followed those claims.
On today’s Big Take podcast, we hear from one of those whistleblowers and Bloomberg health-care reporter John Tozzi about how Medicare Advantage took off and the questions these fraud allegations raise about how taxpayer dollars are spent.
Read more:
- Major Insurers Are Scamming Billions from Medicare, Whistle-Blowers Say
- Medicare Advantage Fraud Case Settled for Up to $100 Million
- UnitedHealth Falls on DOJ Probe Into Medicare Billing
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Bloomberg Audio Studios, podcasts, radio news.
Speaker 2 (00:08):
If you qualify for Medicare, you might actually be covered
by a private insurer. Here's how that works. Medicare Advantage
is the US government's way of offering Americans who are
sixty five and older more options when it comes to
health insurance. People who opt into the program are covered
by private insurers like United Health Group. Those insurers get
(00:30):
a monthly payment from the government to provide coverage for
the people enrolled in their plans. Today, more than half
of the people enrolled in Medicare use a private Medicare
Advantage plan. But last week, a source familiar with the
matter told Bloomberg News that the US Justice Department has
a civil investigation into Medicare billing practices at United Health Group,
(00:52):
one of those participating private insurers. The question at the
center of that investigation, which was first reported by The
Wall Street Journal, is are insurers working the system to
get higher payments from the government.
Speaker 1 (01:05):
Companies invest a tremendous amount of time, effort, money resources
into documenting the illnesses that their members have because it
means money coming in the door, right.
Speaker 2 (01:20):
That's Bloomberg Healthcare reporter John Tazzi.
Speaker 1 (01:22):
But the issue that has emerged is there's some ambiguity
in the rules and in litigation. In cases whistleblowers have
brought to light in audits by federal watchdogs, We've seen
instances of plans pushing or breaking the rules to maximize
the amount they can get paid through the system.
Speaker 2 (01:44):
United Health pushed back in a statement saying the company
wasn't aware of the launch of any new activity and
called suggestions of fraud quote outrageous and falls but the
investigation highlights in ongoing behind the scenes fight between private
insurers and the US government. John spoke with a woman
(02:06):
named Teresa Ross, who worked for another insurer offering Medicare
advantage coverage, a company called Group Health Cooperative in Seattle.
Speaker 3 (02:15):
I joined Group Health Cooperative in May of ninety eight
and loved that organization. I still love a lot of
what it stands for. But I saw my organization that
I loved so much do some things that I wasn't
comfortable with.
Speaker 2 (02:32):
Teresa ultimately reported her concerns to the Department of Justice,
and the practices she blew the whistle on could point
to a major flaw in the Medicare advantage system. One
that might be costing American taxpayers billions of dollars. This
is the big take from Bloomberg News. I'm David Gura
(02:53):
today on the show. Every year more and more Americans
enroll in Medicare advantage plans, but the private company companies
who offer those plans are now under scrutiny, raising questions
about how hundreds of billions of taxpayer dollars are spent.
Every month, part of your paycheck goes directly to a
(03:16):
fund that pays for Medicare, the government health insurance option
for Americans sixty five and older and for some younger
Americans with disabilities. When you enroll in Medicare, you have
two options, a traditional public option where the government pays
doctors directly for tests and services, and something called Medicare advantage.
Here's Bloomberg healthcare reporter John Tazzi.
Speaker 1 (03:38):
Medicare advantage is a privately managed version of Medicare, and
it means you basically get your Medicare benefits through a
private insurance company.
Speaker 2 (03:49):
How long has it been around?
Speaker 1 (03:51):
So it's been around in some form, gosh, probably going
back to the nineteen eighties. Not called Medicare advantage, but
some form of private contract in its current format really
started in the two thousands and has taken off significantly
in the last ten or twelve years. Who've just seen
like rapid growth into this program.
Speaker 2 (04:12):
The number of participants enrolled has actually doubled in the
past decade. Out of the sixty eight million people with
Medicare coverage, over thirty four million people or on a
Medicare advantage plan. John says there are reasons why someone
might choose a private option for Medicare coverage. Advantage plans
sometimes wind up costing participants less by capping out of
(04:32):
pocket costs and offering lower premiums.
Speaker 1 (04:35):
The other thing is that they are able to offer
additional benefits that aren't covered by traditional Medicare. These include
things like dental care, vision, even transportation to medical appointments.
Some plans can help people you know with groceries or
over the counter health products.
Speaker 2 (04:53):
And to incentivize private insurers to cover Americans with various
health conditions, the government created a system call called risk adjustment.
Speaker 1 (05:01):
And this is basically designed to pay plans more for
signing up sicker members. Right, somebody with cancer signs up
for your Medicare advantage plan, they're going to have higher
medical costs than somebody without cancer. The government wants to
make sure that there is money flowing into the plan
to cover that person. This has led to an extremely
(05:24):
complicated set of regulations and processes to determine how much
the government should pay these plans for members with different diagnoses.
Speaker 2 (05:39):
Traditional medicare pays doctors and hospitals directly for a treatment
or a visit, but through Medicare Advantage, the government pays
the private insurer a fixed fee for each patient covered.
Because it's higher risk to ensure someone with a pre
existing condition, the government will pay insurers more to cover
a patient with more severe illnesses. The private insurers report
(06:01):
their patient's conditions to the government through a complicated billing
system using diagnostic codes that represent different illnesses. This is
where Teresa Ross comes in. She was working on risk
adjustment at the private insurer. She worked for Group Health Cooperative,
which means she was managing the diagnostic codes and systems
her company used to track patient's health.
Speaker 3 (06:23):
Their risk adjustment program developed all of the systems and
processes related to making sure that coding was accurate and complete.
Speaker 2 (06:32):
In twenty eleven, Group Health started working with an outside
vendor that looked through patient's charts to identify misdiagnoses. The
stated goal, Teresa said was to improve care to identify
patients who had problems that hadn't been addressed. But medical
coders on Teresa's team were coming to her with concerns.
Speaker 3 (06:51):
There were people all over the place saying, look, this
isn't right. I was taking a closer look too.
Speaker 2 (06:58):
When Teresa looked at the quote und quote misdiagnoses, what
she says she found shocked her.
Speaker 3 (07:04):
Anybody who has oxygen, they were coding with hypoxia, which
is one of the highest payment amounts that you can get.
Speaker 2 (07:12):
That meant anyone getting even a small amount of supplemental
oxygen as part of a treatment was being coded as
having a life threatening condition where the body doesn't absorb
enough oxygen, even though oxygen can be prescribed for less
serious conditions like sleep apnea. And that was just one example.
John Tazzi spoke with Teresa recently about her observations.
Speaker 3 (07:34):
I mean, when you're getting paid by the diagnoses, each
time that they call somebody a diabetic, for example, that
was an extra five hundred bucks in their pocket.
Speaker 1 (07:41):
So you found all these inaccuracies in the codes. How
did you kind of come to the conclusion that this
was intentional? Was there like a time that you kind
of really figured out what was going on here?
Speaker 3 (07:57):
It wasn't, you know, an epiphany one day, More like
over a couple of months of meetings and auditing this stuff.
There were enough of us within the organization that at
least should have known that this was wrong. And all
this is of course, I'm the director of risk adjustment
right at this point, all this is being done under me.
Speaker 2 (08:20):
Kaiser Permanente, which acquired Teresa's former company in twenty seventeen,
has since denied Teresa's allegations. Teresa called her company's internal
whistleblower hotline. She went to leadership and expressed her concerns.
Speaker 3 (08:34):
At every turn, I was overruled, and then they started
excluding me from meetings. I knew I had to do something.
I just knew I can't let this happen.
Speaker 2 (08:45):
So Teresa took another route. She filed a sealed whistleblower
lawsuit against the company, which led the Department of Justice
to pick up her case.
Speaker 3 (08:54):
I actually even wore a wire, so the FBI actually
wired me up.
Speaker 2 (09:01):
Teresa's internal sting operation, what came of it, and what
cases like hers mean for millions of Americans after the break.
After Teresa Ross filed her complaint, the Justice Department started investigating.
(09:22):
Teresa says when a meeting would come up on the
topic of Medicare advantage coding, the FBI would sent her
in with a wire to record what was happening.
Speaker 3 (09:30):
It was extraordinarily stressful. You're always wondering are you going
to be found out when you're wired like that, right,
I mean thinking, you know what a dead battery moment
happens with the recorder, you know, starts beating or something,
and of course that doesn't help your health at all.
So you know, over these you know, several years, I
have actually had some health issues as a result of it.
Speaker 2 (09:53):
It took twelve years after she filed her initial complaint
and started building the case for it to reach a conclusion.
The vendor that worked with Teresa's former company has since
shut down, but its parent company, a New York insurer
called Independent Health, settled her lawsuit for up to ninety
eight million dollars this past December. Teresa will get some
of that money. Independent Health didn't admit liability in the settlement.
(10:16):
It said the agreement would avoid the further disruption, expense,
an uncertainty of litigation in a matter that is lingered
for over a decade. The former CEO of that vendor
also agreed to pay two million dollars to resolve the allegations.
Her attorney said she settled to avoid protracted litigation and
didn't admit any liability. Teresa's former company also settled its
(10:37):
portion of the lawsuit in twenty twenty for six point
three million dollars without admitting liability. A spokesperson for the
company told Bloomberg News in twenty twenty two that it
submitted its data in good faith and relied on the
recommendations of its vendor. Teresa Ross is not the only
whistleblower whose raised concerns about private insurers allegedly exploiting loopholes
(10:58):
in the Medicare advantage system.
Speaker 1 (11:00):
A problem that has been bubbling up for years is
that this system risk adjustment system is subject to manipulation.
Speaker 2 (11:12):
Right, Bloomberg healthcare reporter John Tazzi, Again.
Speaker 1 (11:15):
This is not one anomalous thing that happened at one company.
The kind of activity that she described I think it's
now understood was pretty widespread in the industry.
Speaker 2 (11:28):
In recent years, the Department of Justice has investigated cases
against many of the biggest Medicare advantage providers. The Medicare
Advantage industry disputes the idea that the plans are overpaid.
Industry group Better Medicare Alliance says private plans save the
government money and provide more value for beneficiaries. The group
also says the Medicare Advantage program requires complete and accurate
(11:50):
diagnoses to determine government payments for senior's care. The group
says plans are audited and that it supports comprehensive audits.
The Medicare Payment Advisory Commission, a legislative agency that advises Congress,
says the government overpaid Medicare Advantage plans by more than
five hundred billion dollars since two thousand and seven. That's
compared to what traditional Medicare would have cost to cover
(12:13):
the same people, and with the Medicare fund expected to
run out by twenty thirty six, those billions in overpayments
make a difference. All of this is unfolding as a
contentious fight plays out in Washington over spending in recent weeks,
congressional Republicans suggested cuts to Medicaid, the program that covers
lower income Americans. The Trump administration hasn't threatened Medicare, but
(12:36):
Elon Musk's Doze initiative's goal is to slash federal spending
across the board. During the Biden administration, the government made
an effort to crack down on Medicare advantage over payments.
Speaker 1 (12:47):
The agency that operates Medicare has made some changes. They've
made some adjustments to what's called the risk model that
sort of determines these payments to make it a little
bit less subject to manipulation. They've removed some of the
diagnoses that used to be associated with payment, and that's
(13:08):
hit the companies.
Speaker 2 (13:10):
Some companies have responded. In twenty twenty three, one insurer, Humana,
sued the government in an attempt to block a policy
aimed at cracking down on billions of dollars in alleged overpayments.
Theresa told John she's still adjusting to not living under
constant stress, but the settlement felt good. She said, like
she'd really made a difference because, at the end of
(13:32):
the day, alleged Medicare advantage manipulation impacts any tax paying
American and anyone getting coverage from the plans.
Speaker 1 (13:40):
People need to understand just how vast this program is
and the huge amount of money at stake. The amount
of money involved is hundreds of billions of dollars. It's
a not insignificant portion of the us GDP that runs
(14:02):
through Medicare and Medicare advantage, right, So if there are
systemic manipulation or fraud in this program, that's a huge
amount of taxpayer dollars that are potentially being wasted. I
think the other thing to you know, keep in mind
(14:23):
is it does matter for patients and individuals. If you're
a patient and you know there's something in your medical
chart that is not accurate, you know that could have
consequences for your healthcare.
Speaker 2 (14:36):
I'll ask you lastly, just what do we know about
the Trump administration's approach to this issue or what it
might be if it's still not fully formed.
Speaker 1 (14:43):
I don't think we know a whole lot yet. I
think in general, there's an expectation that Republican administrations in general,
and that the Trump administration will be more favorable to
private insurers, and Republicans have typically in defenders of the
Medicare advantage program. But that said, I think you know,
(15:07):
the attention on this issue in the last couple of
years may have came to the calculus for some people,
particularly when you're looking at people concerned about government spending.
We have Elon Musk looking for ways to cut purportedly
trillions from federal spending. I think anybody who's sort of
familiar with where the federal government's money goes has to
(15:29):
look at Medicare and Medicare advantage.
Speaker 2 (15:32):
John, Thank you very much.
Speaker 1 (15:33):
Thank you.
Speaker 2 (15:37):
This is The Big Take from Bloomberg News. I'm David Gura.
This episode is produced by Julia Press. It was edited
by Aaron Edwards and Emma Port. It was mixed and
sound designed by Alex Sagura and factchecked by Andreana Tapia.
Our senior producer is Naomi Shaven. Our senior editor is
Elizabeth Ponso. Our executive producer is Nicole Beamster. Board Sage
(15:57):
Bauman is Bloomberg's head of podcasts. If you liked this episode,
make sure to subscribe and review The Big Take wherever
you listen to podcasts. It helps people find the show.
Thanks for listening. We'll be back tomorrow,
Bloomberg Audio Studios, podcasts, radio news.
Speaker 2 (00:08):
If you qualify for Medicare, you might actually be covered
by a private insurer. Here's how that works. Medicare Advantage
is the US government's way of offering Americans who are
sixty five and older more options when it comes to
health insurance. People who opt into the program are covered
by private insurers like United Health Group. Those insurers get
(00:30):
a monthly payment from the government to provide coverage for
the people enrolled in their plans. Today, more than half
of the people enrolled in Medicare use a private Medicare
Advantage plan. But last week, a source familiar with the
matter told Bloomberg News that the US Justice Department has
a civil investigation into Medicare billing practices at United Health Group,
(00:52):
one of those participating private insurers. The question at the
center of that investigation, which was first reported by The
Wall Street Journal, is are insurers working the system to
get higher payments from the government.
Speaker 1 (01:05):
Companies invest a tremendous amount of time, effort, money resources
into documenting the illnesses that their members have because it
means money coming in the door, right.
Speaker 2 (01:20):
That's Bloomberg Healthcare reporter John Tazzi.
Speaker 1 (01:22):
But the issue that has emerged is there's some ambiguity
in the rules and in litigation. In cases whistleblowers have
brought to light in audits by federal watchdogs, We've seen
instances of plans pushing or breaking the rules to maximize
the amount they can get paid through the system.
Speaker 2 (01:44):
United Health pushed back in a statement saying the company
wasn't aware of the launch of any new activity and
called suggestions of fraud quote outrageous and falls but the
investigation highlights in ongoing behind the scenes fight between private
insurers and the US government. John spoke with a woman
(02:06):
named Teresa Ross, who worked for another insurer offering Medicare
advantage coverage, a company called Group Health Cooperative in Seattle.
Speaker 3 (02:15):
I joined Group Health Cooperative in May of ninety eight
and loved that organization. I still love a lot of
what it stands for. But I saw my organization that
I loved so much do some things that I wasn't
comfortable with.
Speaker 2 (02:32):
Teresa ultimately reported her concerns to the Department of Justice,
and the practices she blew the whistle on could point
to a major flaw in the Medicare advantage system. One
that might be costing American taxpayers billions of dollars. This
is the big take from Bloomberg News. I'm David Gura
(02:53):
today on the show. Every year more and more Americans
enroll in Medicare advantage plans, but the private company companies
who offer those plans are now under scrutiny, raising questions
about how hundreds of billions of taxpayer dollars are spent.
Every month, part of your paycheck goes directly to a
(03:16):
fund that pays for Medicare, the government health insurance option
for Americans sixty five and older and for some younger
Americans with disabilities. When you enroll in Medicare, you have
two options, a traditional public option where the government pays
doctors directly for tests and services, and something called Medicare advantage.
Here's Bloomberg healthcare reporter John Tazzi.
Speaker 1 (03:38):
Medicare advantage is a privately managed version of Medicare, and
it means you basically get your Medicare benefits through a
private insurance company.
Speaker 2 (03:49):
How long has it been around?
Speaker 1 (03:51):
So it's been around in some form, gosh, probably going
back to the nineteen eighties. Not called Medicare advantage, but
some form of private contract in its current format really
started in the two thousands and has taken off significantly
in the last ten or twelve years. Who've just seen
like rapid growth into this program.
Speaker 2 (04:12):
The number of participants enrolled has actually doubled in the
past decade. Out of the sixty eight million people with
Medicare coverage, over thirty four million people or on a
Medicare advantage plan. John says there are reasons why someone
might choose a private option for Medicare coverage. Advantage plans
sometimes wind up costing participants less by capping out of
(04:32):
pocket costs and offering lower premiums.
Speaker 1 (04:35):
The other thing is that they are able to offer
additional benefits that aren't covered by traditional Medicare. These include
things like dental care, vision, even transportation to medical appointments.
Some plans can help people you know with groceries or
over the counter health products.
Speaker 2 (04:53):
And to incentivize private insurers to cover Americans with various
health conditions, the government created a system call called risk adjustment.
Speaker 1 (05:01):
And this is basically designed to pay plans more for
signing up sicker members. Right, somebody with cancer signs up
for your Medicare advantage plan, they're going to have higher
medical costs than somebody without cancer. The government wants to
make sure that there is money flowing into the plan
to cover that person. This has led to an extremely
(05:24):
complicated set of regulations and processes to determine how much
the government should pay these plans for members with different diagnoses.
Speaker 2 (05:39):
Traditional medicare pays doctors and hospitals directly for a treatment
or a visit, but through Medicare Advantage, the government pays
the private insurer a fixed fee for each patient covered.
Because it's higher risk to ensure someone with a pre
existing condition, the government will pay insurers more to cover
a patient with more severe illnesses. The private insurers report
(06:01):
their patient's conditions to the government through a complicated billing
system using diagnostic codes that represent different illnesses. This is
where Teresa Ross comes in. She was working on risk
adjustment at the private insurer. She worked for Group Health Cooperative,
which means she was managing the diagnostic codes and systems
her company used to track patient's health.
Speaker 3 (06:23):
Their risk adjustment program developed all of the systems and
processes related to making sure that coding was accurate and complete.
Speaker 2 (06:32):
In twenty eleven, Group Health started working with an outside
vendor that looked through patient's charts to identify misdiagnoses. The
stated goal, Teresa said was to improve care to identify
patients who had problems that hadn't been addressed. But medical
coders on Teresa's team were coming to her with concerns.
Speaker 3 (06:51):
There were people all over the place saying, look, this
isn't right. I was taking a closer look too.
Speaker 2 (06:58):
When Teresa looked at the quote und quote misdiagnoses, what
she says she found shocked her.
Speaker 3 (07:04):
Anybody who has oxygen, they were coding with hypoxia, which
is one of the highest payment amounts that you can get.
Speaker 2 (07:12):
That meant anyone getting even a small amount of supplemental
oxygen as part of a treatment was being coded as
having a life threatening condition where the body doesn't absorb
enough oxygen, even though oxygen can be prescribed for less
serious conditions like sleep apnea. And that was just one example.
John Tazzi spoke with Teresa recently about her observations.
Speaker 3 (07:34):
I mean, when you're getting paid by the diagnoses, each
time that they call somebody a diabetic, for example, that
was an extra five hundred bucks in their pocket.
Speaker 1 (07:41):
So you found all these inaccuracies in the codes. How
did you kind of come to the conclusion that this
was intentional? Was there like a time that you kind
of really figured out what was going on here?
Speaker 3 (07:57):
It wasn't, you know, an epiphany one day, More like
over a couple of months of meetings and auditing this stuff.
There were enough of us within the organization that at
least should have known that this was wrong. And all
this is of course, I'm the director of risk adjustment
right at this point, all this is being done under me.
Speaker 2 (08:20):
Kaiser Permanente, which acquired Teresa's former company in twenty seventeen,
has since denied Teresa's allegations. Teresa called her company's internal
whistleblower hotline. She went to leadership and expressed her concerns.
Speaker 3 (08:34):
At every turn, I was overruled, and then they started
excluding me from meetings. I knew I had to do something.
I just knew I can't let this happen.
Speaker 2 (08:45):
So Teresa took another route. She filed a sealed whistleblower
lawsuit against the company, which led the Department of Justice
to pick up her case.
Speaker 3 (08:54):
I actually even wore a wire, so the FBI actually
wired me up.
Speaker 2 (09:01):
Teresa's internal sting operation, what came of it, and what
cases like hers mean for millions of Americans after the break.
After Teresa Ross filed her complaint, the Justice Department started investigating.
(09:22):
Teresa says when a meeting would come up on the
topic of Medicare advantage coding, the FBI would sent her
in with a wire to record what was happening.
Speaker 3 (09:30):
It was extraordinarily stressful. You're always wondering are you going
to be found out when you're wired like that, right,
I mean thinking, you know what a dead battery moment
happens with the recorder, you know, starts beating or something,
and of course that doesn't help your health at all.
So you know, over these you know, several years, I
have actually had some health issues as a result of it.
Speaker 2 (09:53):
It took twelve years after she filed her initial complaint
and started building the case for it to reach a conclusion.
The vendor that worked with Teresa's former company has since
shut down, but its parent company, a New York insurer
called Independent Health, settled her lawsuit for up to ninety
eight million dollars this past December. Teresa will get some
of that money. Independent Health didn't admit liability in the settlement.
(10:16):
It said the agreement would avoid the further disruption, expense,
an uncertainty of litigation in a matter that is lingered
for over a decade. The former CEO of that vendor
also agreed to pay two million dollars to resolve the allegations.
Her attorney said she settled to avoid protracted litigation and
didn't admit any liability. Teresa's former company also settled its
(10:37):
portion of the lawsuit in twenty twenty for six point
three million dollars without admitting liability. A spokesperson for the
company told Bloomberg News in twenty twenty two that it
submitted its data in good faith and relied on the
recommendations of its vendor. Teresa Ross is not the only
whistleblower whose raised concerns about private insurers allegedly exploiting loopholes
(10:58):
in the Medicare advantage system.
Speaker 1 (11:00):
A problem that has been bubbling up for years is
that this system risk adjustment system is subject to manipulation.
Speaker 2 (11:12):
Right, Bloomberg healthcare reporter John Tazzi, Again.
Speaker 1 (11:15):
This is not one anomalous thing that happened at one company.
The kind of activity that she described I think it's
now understood was pretty widespread in the industry.
Speaker 2 (11:28):
In recent years, the Department of Justice has investigated cases
against many of the biggest Medicare advantage providers. The Medicare
Advantage industry disputes the idea that the plans are overpaid.
Industry group Better Medicare Alliance says private plans save the
government money and provide more value for beneficiaries. The group
also says the Medicare Advantage program requires complete and accurate
(11:50):
diagnoses to determine government payments for senior's care. The group
says plans are audited and that it supports comprehensive audits.
The Medicare Payment Advisory Commission, a legislative agency that advises Congress,
says the government overpaid Medicare Advantage plans by more than
five hundred billion dollars since two thousand and seven. That's
compared to what traditional Medicare would have cost to cover
(12:13):
the same people, and with the Medicare fund expected to
run out by twenty thirty six, those billions in overpayments
make a difference. All of this is unfolding as a
contentious fight plays out in Washington over spending in recent weeks,
congressional Republicans suggested cuts to Medicaid, the program that covers
lower income Americans. The Trump administration hasn't threatened Medicare, but
(12:36):
Elon Musk's Doze initiative's goal is to slash federal spending
across the board. During the Biden administration, the government made
an effort to crack down on Medicare advantage over payments.
Speaker 1 (12:47):
The agency that operates Medicare has made some changes. They've
made some adjustments to what's called the risk model that
sort of determines these payments to make it a little
bit less subject to manipulation. They've removed some of the
diagnoses that used to be associated with payment, and that's
(13:08):
hit the companies.
Speaker 2 (13:10):
Some companies have responded. In twenty twenty three, one insurer, Humana,
sued the government in an attempt to block a policy
aimed at cracking down on billions of dollars in alleged overpayments.
Theresa told John she's still adjusting to not living under
constant stress, but the settlement felt good. She said, like
she'd really made a difference because, at the end of
(13:32):
the day, alleged Medicare advantage manipulation impacts any tax paying
American and anyone getting coverage from the plans.
Speaker 1 (13:40):
People need to understand just how vast this program is
and the huge amount of money at stake. The amount
of money involved is hundreds of billions of dollars. It's
a not insignificant portion of the us GDP that runs
(14:02):
through Medicare and Medicare advantage, right, So if there are
systemic manipulation or fraud in this program, that's a huge
amount of taxpayer dollars that are potentially being wasted. I
think the other thing to you know, keep in mind
(14:23):
is it does matter for patients and individuals. If you're
a patient and you know there's something in your medical
chart that is not accurate, you know that could have
consequences for your healthcare.
Speaker 2 (14:36):
I'll ask you lastly, just what do we know about
the Trump administration's approach to this issue or what it
might be if it's still not fully formed.
Speaker 1 (14:43):
I don't think we know a whole lot yet. I
think in general, there's an expectation that Republican administrations in general,
and that the Trump administration will be more favorable to
private insurers, and Republicans have typically in defenders of the
Medicare advantage program. But that said, I think you know,
(15:07):
the attention on this issue in the last couple of
years may have came to the calculus for some people,
particularly when you're looking at people concerned about government spending.
We have Elon Musk looking for ways to cut purportedly
trillions from federal spending. I think anybody who's sort of
familiar with where the federal government's money goes has to
(15:29):
look at Medicare and Medicare advantage.
Speaker 2 (15:32):
John, Thank you very much.
Speaker 1 (15:33):
Thank you.
Speaker 2 (15:37):
This is The Big Take from Bloomberg News. I'm David Gura.
This episode is produced by Julia Press. It was edited
by Aaron Edwards and Emma Port. It was mixed and
sound designed by Alex Sagura and factchecked by Andreana Tapia.
Our senior producer is Naomi Shaven. Our senior editor is
Elizabeth Ponso. Our executive producer is Nicole Beamster. Board Sage
(15:57):
Bauman is Bloomberg's head of podcasts. If you liked this episode,
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