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Posted on 04/28/2026 8:04:57 PM PDT by SeekAndFind
Polls show Americans are angry – and rightly so – at accelerating medical bills. Meanwhile, the insurers and hospitals keep raking in record profits.
UnitedHealthcare just reported jumbo profits so far in 2026, and in 2025, it recorded revenues of more than $400 billion. It is raking in profits from the $1.9 trillion in federal healthcare programs.
Two of the largest "nonprofit" hospital chains, Kaiser Permanente and HCA Healthcare, recorded nearly $200 billion in assets at the end of 2024. As Republican Rep. Jason Smith (MO-8), chairman of the House Ways and Means Committee, put it: "Hospitals are charging an insane amount. Hospital prices have skyrocketed 300 percent in just over two decades – more than any other sector of our economy."
A major driver of costs is the fraudulent claims paid out by the government to health insurers and hospitals. Much of the scam billings are charged to the half-trillion-dollar Medicare Advantage program.
Here's one way they get away with it.
Medicare payments are based on a patient's risk factors or diagnosed conditions – not payments for actual healthcare services. Medicare Advantage enrollees are healthier on average than traditional Medicare beneficiaries, yet insurers consistently inflate patient risk scores so they can bilk more money from Uncle Sam.
This scheme is known as "upcoding." By exaggerating the patients' health problems, insurers collect larger payments from government without providing additional healthcare. It's the healthcare equivalent of a driver filing an insurance claim for a fender-bender and seeking reimbursement for much more than the repairs actually cost.
The Medicare Advantage program is supposed to be a free-market supplement to Medicare. But the rules are written as if to fatten the wallets of the hospital and insurance giants – while the taxpayers and employers eat the costs.
Some of my Republican friends argue that Medicare Advantage is a free-market insurance program. Really?
The GOP's Doctors Caucus – people who treat patients firsthand – has increasingly warned that insurers are extracting billions in payments that bear no relation to patients' actual medical needs.
The Trump administration is finally ending this blank-check billing scheme. In January, the administration stunned Medicare Advantage insurers by rejecting a "big boost" in payments. Instead, President Donald Trump wants reforms to root out "upcoding" fraud that pads insurers' profits.
Here's another commonsense way to save money on healthcare. Trump's Centers for Medicare & Medicaid Services has proposed excluding diagnoses added by an insurer that merely reviews patient records but never actually sees the patient. CMS projects that eliminating such diagnoses would save taxpayers some $7 billion next year alone.
One piece of good news is that some states are auditing hospital billing practices. Indiana's House just unanimously passed the "payment of health claims" law pushed by Republican Gov. Mike Braun that will root out phony reimbursement scams.
States like Arkansas, Virginia, and Ohio are now following Indiana's lead, and Congress should, too.
The savings impact of reining in Medicare Advantage fraud reaches into the high tens of billions of dollars every year – money that is effectively stolen from taxpayers and employers. Medicare Advantage is now covering more than half of American seniors.
For too long, fraudulent medical care billing has been treated like a ho-hum cost of doing business in Washington and state capitals. It isn't. It's theft. The victims are patients, employers, doctors, and taxpayers.
Trump and Braun should be applauded for demanding that private insurance companies stop bilking taxpayers. If insurers and hospitals keep getting rich by cheating, they should be thrown out of the program.
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Click here: to donate by Credit Card Or here: to donate by PayPal Or by mail to: Free Republic, LLC - PO Box 9771 - Fresno, CA 93794 Thank you very much and God bless you. |
I have an old phone number I ported to google voice because of too many spam calls (about 100/day). Occasionally while cleaning it out (checking for stray real messages) I’ll get a call or 2 or 3. If a product (medicare advantage) needs half of india calling my about medicare advantage the programs must really suck.
Hospitals charge outrageous prices because they can county to ‘no pays’ as tax write offs... big losses. Of course the insurance, advantage plans, Medicare etc deal those prices down to almost nothing. The lone American is screwed - illegals pay nothing and their high charges are written off.
The medical system in the US was designed by the same monsters who made horrible trade deals with foreign countries before President Trump put a stop to that crap.
They had to replace the $42,000 they got for every “COVID” patient they slapped on a ventilator and pumped full of Remdesivir to death.
.
I don’t doubt plenty of fraud and abuse.
That’s not the major issue though.
If we want medical prices to come down, the things that will make prices come down will never be requested.
EMTALA needs to be abolished. Medicare needs to be abolished. Obamacare needs to be abolished. Medicaid needs to be abolished.
BoomerCons will never support it. That leaves about 10 Americans left capable and willing to fix medical pricing problems.
We can’t fight the Democrats until we can overcome the problem of the BoomerCons protecting huge massive government at all angles.
I would agree with Steve on some point but it is not insurance. You don’t use car insurance to change your oil. So it’s not insurance when it pays for routine office visits to a doctor. Also there are huge regulatory stuff at the state level. A $6B company might need a $1B reserve. At $400B United might need meet 56 state requirement for reserves at around $66B
Anyone have any idea why Trump is commuting sentences for these fraudsters?
For health care, bring on market force:
1. Break most hospitals into two highly competitive entities.
2. Convert other hospitals into real estate leasing entities with competing surgical suites and nursing wings.
3. Separate out drug coverage so hospital systems can run care coverage systems and cut out insurance company overhead and meddlers.
4. Create interstate drug plans that don’t have to pay what the drugmaker wants for every drug. To qualify for exchange listing and federal subsidies, they would have to most (~80% or more) in all important types (large volume recombinant, small volume recombinant, breakthroughs under patent, etc.). Group and exchange plans to offer time-limited vouchers at plan set amounts for out-of-formulary drugs. Voucher plans would have variable premiums. Plans without minimums (or vouchers) could be vended directly to individuals and families.
5. These plans would be all the doctors (and AI) prescribe for formulary drugs with co-pays equal to manufacturing cost
“Anyone have any idea why Trump is commuting sentences for these fraudsters?”
I suspect highly that Trump is very susceptible to tales of woe, especially if uttered by a comely female.
Charles III only gets to issue royal pardons for those the bureaucrats & ruling politicians both approve of.
Part B
$100 of care
$20 - patient co-pay
$80 balance
1/4th - paid for by Part B premiums
$60 balance
~25% of $100 - paid for by doctor’s and suppliers’ income tax
~$35 subsidy from third party taxpayers
“Part A is funded primarily by payroll taxes”
https://www.kff.org/medicare/what-to-know-about-medicare-spending-and-financing/
I’m on my fourth Medicare card because my info is tied up in a big fraud case on the east coast, NY state I think. I was getting billed for bladder procedures and equipment $2,000+ each time. Before I had a chance to figure it out and call Medicare, they called me and said FBI was taking chg of the case. That was 2, maybe 3 years ago. No more phone calls but I regularly get a new Medicare card. I get the side eye from a lot of medical associates.
There are other ways, too.
Whole floors in big name hospitals set apart for foreign dignitaries who want top shelf medical treatment and are treated in ways the average American patient couldn’t even dream of.
And they come with significant donations in appreciation.
And guess who collects the money? Not the doctors and nurses caring for them.
I had emergency surgery in Texas about 15 years ago. When they thought I was insured they told me the bill was $70k. When I said I am paying cash they said $14k without blinking. Such a scam. Of course being Texas, every illegal was in the emergency room getting free care thanks to translators and “care coordinators” making sure they got all the gibs.
On Medicare on Medicaid?
You are not the customer.
You are the pass-through to insurance companies.
When illegals don’t pay the outrageous hospital bills, their debt is used for tax write offs...
If you use see a healthcare professional who works for a health system, you may be the patient, but your HCP doesn’t work for you.
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