Private insurers have been selling Medicare Advantage (MA) plans specifically aimed at veterans, promising to cover any gaps in U.S. Department of Veterans Affairs coverage. Speaking with an experienced Medicare Advantage fraud whistleblower attorney can help veterans and insiders expose when these promises fall short.
That could be great — if the plans ended up providing useful coverage. But a research article published by Health Affairs found that the plans end up with private insurers billing the federal government for little to no actual services.
It’s no drop in the bucket, either: “In 2020, the Centers for Medicare and Medicaid Services paid more than $1.32 billion to MA plans for VHA enrollees who did not use any Medicare services, with 19.1 percent going to high-veteran MA plan,” the article stated.
During the past decade, veteran enrollment in Medicare Advantage plans, also known as Medicare Part C or managed care, has jumped, as has the number of MA plans specifically marketed to veterans. In 2022, according to Health Affairs, about 34 percent of the Medicare-enrolled veteran population was enrolled in an MA plan.
Keep in mind that the federal government also is paying for the care provided by the VA — so effectively, it’s paying twice for the same thing (which wouldn’t happen with traditional Medicare).
The idea behind Medicare Advantage was a cheaper, more comprehensive option than traditional Medicare, but — boosted by fraud — it’s proving to be much more expensive.
Beyond veterans, allegations have been mounting that private insurance companies take advantage of the MA program at high cost to the federal government (and thus, to taxpayers). That includes fraud such as diagnosing health conditions that don’t require medical services, making questionable diagnoses that require extra payments, establishing kickback schemes to sell seniors care they don’t need, and alleged anticompetitive or unfair rebating practices that inflated insulin prices.
The government is trying to stop all this fraud, but it’s a massive job. For fiscal 2024, the DOJ announced more than $2.9 billion in settlements connected to fraud against the federal government, with over $1.67 billion of the total stemming from healthcare fraud.
Whistleblowers are invaluable aids in putting a stop to fraud and keeping public money from padding private companies’ profits.
The federal False Claims Act incentivizes whistleblowers to report fraud against the government by rewarding them with a portion (typically 15-30 percent) of the amount the government recovers as a result of the whistleblower’s case. According to the Taxpayers Against Fraud Education Fund, between 2010 and 2020, the government’s FCA recoveries totaled $40.2 billion. Of that total, about 68 percent came from healthcare-related recoveries. (Whistleblowers also may be able to remain anonymous, and they have protections from retaliation.)
Keller Grover represented a whistleblower in a landmark $90 million settlement against Sutter Health over allegations that the organization committed massive Medicare Advantage fraud over a six-year period.
If you know something about fraud against the government, you could help stem the tidal wave of fraud. Keller Grover has a long history of helping whistleblowers expose wrongdoing. Speaking with a knowledgeable Medicare Advantage fraud whistleblower attorney can help you understand your rights, strengthen your claim, and protect against retaliation. If you would like more information, or have a potential case, contact us for a free confidential consultation.