Health Company Accused of Medicare Fraud, Not the Health Policy Causing It
The mainstream media breathlessly covers a spat between Ballad Health and UnitedHealthcare, with Ballad alleging UnitedHealthcare employs 'Medicare Advantage manipulation.' Newsweek, in its dedication to hard-hitting journalism, presents this as a corporate squabble. Yet, they conveniently ignore the elephant in the room: the very design of Medicare Advantage (MA) incentivizes over-diagnosis and
upcoding. UnitedHealthcare, the largest MA provider, has faced numerous lawsuits and government probes for these exact practices, with a 2022 federal audit alleging they overcharged the government by billions. (See: Office of Inspector General reports on Medicare Advantage). We have a system where private companies profit by navigating complex incentive structures, and when caught, it's framed as
'manipulation' rather than a feature. It's almost as if the architects of these 'advantage' plans designed them with robust profit margins in mind, not patient care. How many times will we blame the chess player for moving their pieces when the board itself is rigged?