• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Footnote

Footnote.co

Showcasing research with the power to change our world

  • Facebook
  • Twitter
Footnote
  • About
  • Contributors
  • Partner With Us
  • Press
  • Projects
  • Academia
  • Business
  • Education
  • Government
  • Health
  • International
  • Science
  • Society
  • Technology
OVERPAID PLANS

How Medicare Can Save $500 Billion

Andrew Ryan and David Meyers, Brown UniversityAugust 18, 2023November 2, 2023
doctor with patient
Sections
  • Health
Topics
  • Health Care Spending
  • Medicaid & Medicare

In 2021, the United States settled a lawsuit against California health care provider Sutter Health for $90 million. According to the suit, Sutter siphoned government money by falsely labeling temporary conditions as chronic, pressuring physicians to add unnecessary conditions to charts, and even revising patient records behind doctors’ backs.

Sutter’s alleged misrepresentation of its patients’ health isn’t isolated. So-called “upcoding” for Medicare Advantage (MA) beneficiaries costs the federal government an estimated $10 billion to $50 billion each year. But upcoding and other forms of fraud are just a small slice of the waste happening in MA, a privately-managed, publicly-funded alternative to traditional Medicare for older Americans. Over the next decade, taxpayers stand to lose hundreds of billions of dollars due to faulty rules that overpay MA plans and providers.

Some rules are baked into Medicare and will require Congressional action to change. But, according to our latest research, the Centers for Medicare & Medicaid Services (CMS) has immediate authority to save $500 billion by adjusting its approach to estimating MA patients’ health risks. On the whole, MA beneficiaries are less sick than plans claim and healthier than people in regular Medicare, meaning CMS can cut costs without cutting care.

Read the full article at The Boston Globe.

This article was produced by Footnote in partnership with Brown University.

Related

  1. healthcare expenses
    How A Simple Tax Could Slow The Alarming Growth In Medicare Spending

  2. How We Can Save By Coordinating Medicare & Medicaid
  3. healthcare expenses
    Families Spend 17% Of Their Income On Health Insurance

sidebar

Contributed by

Andrew Ryan

Andrew Ryan

Director, Center for Health Policy
Professor of Health Services, Policy and Practice
Brown University and University of Michigan

Dr. Ryan is a professor in the Department of Health Services, Policy, and Practice at Brown University. Prior to his appointment at Brown, Dr. Ryan was a professor at the University of Michigan. Dr. Ryan’s research focuses on understanding and evaluating the effects of health care payment reform.

David Meyers

David Meyers

Associate Director the Center for Advancing Health Policy Through Research
Assistant Professor of Health Services, Policy and Practice
Brown University

David J Meyers, PhD, MPH, is a health services researcher and health economist whose research broadly focuses on how payment and delivery reform affect the outcomes of historically marginalized patient populations.

Footer

About Footnote

Footnote is an online media company that increases the impact of academic knowledge by making it accessible and engaging for new audiences.

Learn more about Footnote and our contributors.

Follow us on Facebook and Twitter.

Partner with us to increase the impact of your research.

Sections

  • Academia
  • Business
  • Education
  • Government
  • Health
  • International
  • Science
  • Society
  • Technology

Projects

  • Babson College
  • The Collaborative
  • Genomic Medicine
  • Making Research Reliable
  • Robotics
  • Works Cited Podcast

© 2025 Footnote