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The problem with upcoding under Medicare Advantage

On July 30, 1965, President Johnson signed Medicare into law, allowing millions of seniors to access health care. On the occasion of Medicare’s 58th birthday, Medicare is under threat. Efforts to privatize Medicare are eroding this landmark program, allowing the greed of a few to threaten the well-being of us all.

The Medicare Advantage program is diverting billions of dollars a year to corporate profiteering. Through the process of “upcoding” (making patients look sicker than they actually are), insurance corporations have been overpaid by taxpayers to the tune of tens of billions of dollars.

Here’s how “upcoding” happens: I am 66 years old, in good health. I am enrolled in a Medicare Advantage plan. I am getting several calls each month from the insurance company, urging me to take advantage of a “free” health screening. The purpose of this home health visit is not to provide health care. Rather, its purpose is to “upcode”: to add irrelevant diagnoses to my medical history just to increase the insurance company’s payout.

President Biden has taken some steps to try to rein in the practice of upcoding, but he can do more. Therefore, on the occasion of Medicare’s 58th birthday, I am encouraging President Biden to take executive action to prohibit upcoding, and to stop overpayments to Medicare Advantage. The tax dollars saved can be used to improve traditional Medicare — eliminating deductibles and expanding coverage to include dental, vision and hearing — so that we have the freedom to just choose Medicare, not a privatized plan.

Julie Pease

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