Instead of ripping away health care from millions of people, Republicans should crack down on waste in Medicare Advantage.
Tactics like "upcoding"—when for-profit insurance companies exaggerate medical problems to pad their profits—cost taxpayers billions. That’s real waste.
Tactics like "upcoding"—when for-profit insurance companies exaggerate medical problems to pad their profits—cost taxpayers billions. That’s real waste.
Democrats push GOP toward Medicare ‘upcoding’ instead of Medicaid cuts
Democratic lawmakers are asking GOP leadership to reject Medicaid cuts in favor of going after Medicare Advantage “upcoding” as a way of saving federal dollars and addressing waste, fra…
thehill.com
May 12, 2025 at 1:45 PM
Instead of ripping away health care from millions of people, Republicans should crack down on waste in Medicare Advantage.
Tactics like "upcoding"—when for-profit insurance companies exaggerate medical problems to pad their profits—cost taxpayers billions. That’s real waste.
Tactics like "upcoding"—when for-profit insurance companies exaggerate medical problems to pad their profits—cost taxpayers billions. That’s real waste.
The biggest known source of wasteful and semi-fraudulent health spending is Medicare Advantage upcoding schemes, and the top OMB health policy guy is a Medicare Advantage lobbyist.
Foxes guarding the henhouse.
www.slowboring.com/p/cutting-he...
Foxes guarding the henhouse.
www.slowboring.com/p/cutting-he...
March 4, 2025 at 12:50 PM
The biggest known source of wasteful and semi-fraudulent health spending is Medicare Advantage upcoding schemes, and the top OMB health policy guy is a Medicare Advantage lobbyist.
Foxes guarding the henhouse.
www.slowboring.com/p/cutting-he...
Foxes guarding the henhouse.
www.slowboring.com/p/cutting-he...
the interesting thing is that they have seemingly found nothing worth talking about with respect to Medicare upcoding, which is rather strange because that is the area where there is a lot of fraud.
March 10, 2025 at 9:23 PM
the interesting thing is that they have seemingly found nothing worth talking about with respect to Medicare upcoding, which is rather strange because that is the area where there is a lot of fraud.
Yeah it's called upcoding
April 30, 2026 at 1:30 PM
Yeah it's called upcoding
NEWS on the Big Beautiful Bill:
1-Medicare changes are out. It was stupid to believe that these Republicans were ever going to fix upcoding, but it's now confirmed that they won't.
1-Medicare changes are out. It was stupid to believe that these Republicans were ever going to fix upcoding, but it's now confirmed that they won't.
June 13, 2025 at 8:08 PM
NEWS on the Big Beautiful Bill:
1-Medicare changes are out. It was stupid to believe that these Republicans were ever going to fix upcoding, but it's now confirmed that they won't.
1-Medicare changes are out. It was stupid to believe that these Republicans were ever going to fix upcoding, but it's now confirmed that they won't.
More evidence of rampant upcoding in Medicare
"Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011–19" now out in Health Affairs
www.healthaffairs.org/doi/abs/10.1...
"Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011–19" now out in Health Affairs
www.healthaffairs.org/doi/abs/10.1...
December 31, 2024 at 9:17 PM
More evidence of rampant upcoding in Medicare
"Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011–19" now out in Health Affairs
www.healthaffairs.org/doi/abs/10.1...
"Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011–19" now out in Health Affairs
www.healthaffairs.org/doi/abs/10.1...
Politico is now reporting that the Senate is going to cut more deeply into the Medicaid provider tax.
If you read @prospect.org, you would have known this hours earlier.
No credit, ofc.
Read @prospect.org, get the news first.
prospect.org/politics/202...
If you read @prospect.org, you would have known this hours earlier.
No credit, ofc.
Read @prospect.org, get the news first.
prospect.org/politics/202...
June 16, 2025 at 5:58 PM
Politico is now reporting that the Senate is going to cut more deeply into the Medicaid provider tax.
If you read @prospect.org, you would have known this hours earlier.
No credit, ofc.
Read @prospect.org, get the news first.
prospect.org/politics/202...
If you read @prospect.org, you would have known this hours earlier.
No credit, ofc.
Read @prospect.org, get the news first.
prospect.org/politics/202...
You can find public records of trainings focused on "upcoding" to maximize payments by making patients seem sicker than they are (esp for Medicare Advantage plans)
And let's be clear that Medicare 'fraud' is largely done by health insurance companies (e.g. Medicare Advantage plans) and health care executives (e.g. Rick Scott). www.nytimes.com/2022/10/08/u...
February 5, 2025 at 5:58 PM
You can find public records of trainings focused on "upcoding" to maximize payments by making patients seem sicker than they are (esp for Medicare Advantage plans)
I was asking only a few months ago how it was that DOGE had not managed to discover Medicare upcoding, and I guess now I have my answer
It’s incredible that he does this as Mike Johnson is out there accusing recipients of widespread fraud.
June 2, 2025 at 6:24 PM
I was asking only a few months ago how it was that DOGE had not managed to discover Medicare upcoding, and I guess now I have my answer
The DOJ has just opened an investigation in wasteful billing practices, including diagnostic upcoding, at UnitedHealth's Medicare Advantage program.
What's upcoding? When does makes a medical billing practice fraudulent?
All answered on this week's ep —>
open.spotify.com/episode/1lTP...
What's upcoding? When does makes a medical billing practice fraudulent?
All answered on this week's ep —>
open.spotify.com/episode/1lTP...
The Trump-Musk Doctrine: F-ck Around and Find Out
Plain English with Derek Thompson · Episode
open.spotify.com
February 21, 2025 at 2:48 PM
The DOJ has just opened an investigation in wasteful billing practices, including diagnostic upcoding, at UnitedHealth's Medicare Advantage program.
What's upcoding? When does makes a medical billing practice fraudulent?
All answered on this week's ep —>
open.spotify.com/episode/1lTP...
What's upcoding? When does makes a medical billing practice fraudulent?
All answered on this week's ep —>
open.spotify.com/episode/1lTP...
ICE/CBP swarms into Minnesota after reports of massive government fraud.
Somehow they sidestepped the orders-of-magnitude higher government fraud from Minnesota-based UnitedHealth, who leads a Medicare Advantage fraud that MedPac (a government analyst) estimates as costing America $76 billion/year
Somehow they sidestepped the orders-of-magnitude higher government fraud from Minnesota-based UnitedHealth, who leads a Medicare Advantage fraud that MedPac (a government analyst) estimates as costing America $76 billion/year
January 27, 2026 at 11:07 PM
ICE/CBP swarms into Minnesota after reports of massive government fraud.
Somehow they sidestepped the orders-of-magnitude higher government fraud from Minnesota-based UnitedHealth, who leads a Medicare Advantage fraud that MedPac (a government analyst) estimates as costing America $76 billion/year
Somehow they sidestepped the orders-of-magnitude higher government fraud from Minnesota-based UnitedHealth, who leads a Medicare Advantage fraud that MedPac (a government analyst) estimates as costing America $76 billion/year
Is it "upcoding" – a quiet way of accusing physicians of fraud – or are coding and documentation practices only just gradually catching up to the actual complexity of outpatient care?
#medsky
www.trillianthealth.com/market-resea...
#medsky
www.trillianthealth.com/market-resea...
Changes in Coding Intensity Suggest How Upcoding Is Happening Across Outpatient Settings
A trend toward higher-acuity billing across settings of care has raised concerns about “upcoding” – the effects of which extend beyond payer reimbursements.
www.trillianthealth.com
May 17, 2025 at 10:24 PM
Is it "upcoding" – a quiet way of accusing physicians of fraud – or are coding and documentation practices only just gradually catching up to the actual complexity of outpatient care?
#medsky
www.trillianthealth.com/market-resea...
#medsky
www.trillianthealth.com/market-resea...
MAGA Senator Rick Scott, while serving as CEO of HCA Healthcare, oversaw the corporation's involvement in largest health care fraud case in U.S. history. The company systematically defrauded federal programs through unlawful billing practices, illegal kickbacks to physicians, and upcoding diagnoses
July 25, 2026 at 1:03 PM
MAGA Senator Rick Scott, while serving as CEO of HCA Healthcare, oversaw the corporation's involvement in largest health care fraud case in U.S. history. The company systematically defrauded federal programs through unlawful billing practices, illegal kickbacks to physicians, and upcoding diagnoses
I notice that it is now one month later, and the DOGE youths have found considerably less upcoding than you might have expected from a monkey throwing darts at the filing cabinet. perhaps someone had a quiet word about how dangerous open windows can be.
this might be a dog catches the car moment. because if you can't find fraud in the Medicare and Medicaid programs, that's really going to raise questions of competence. but if you do find fraud in the Medicare and Medicaid programs, you trigger some really mean and well resourced enemies.
Exclusive: DOGE aides have access to payment systems at the agency that oversees Medicare and Medicaid
March 5, 2025 at 1:13 AM
I notice that it is now one month later, and the DOGE youths have found considerably less upcoding than you might have expected from a monkey throwing darts at the filing cabinet. perhaps someone had a quiet word about how dangerous open windows can be.
'Revenue-generating diagnoses': DOJ investigates UnitedHealth Group for fraud: The Justice Department is reportedly investigating UnitedHealth Group for fraud related to upcoding — encouraging doctors to diagnose patients with conditions they do not have for profit. The group has been the target of…
'Revenue-generating diagnoses': DOJ investigates UnitedHealth Group for fraud
The Justice Department is reportedly investigating UnitedHealth Group for fraud related to upcoding — encouraging doctors to diagnose patients with conditions they do not have for profit. The group has been the target of anger regarding the health…
www.alternet.org
February 21, 2025 at 4:03 PM
'Revenue-generating diagnoses': DOJ investigates UnitedHealth Group for fraud: The Justice Department is reportedly investigating UnitedHealth Group for fraud related to upcoding — encouraging doctors to diagnose patients with conditions they do not have for profit. The group has been the target of…
Private insurers have always benefited from favorable selection relative to traditional Medicare and because of inadequate risk adjustment (driven in large part by upcoding) that leads to overpayments. MedPAC has been estimating the size of the overpayments for many years, as have outside analysts.
GOP aims to change Medicare adviser’s math so it’s more favorable to health insurers
Lawmakers advance bill to change how MedPAC studies spending
www.statnews.com/2026/09/16/m...
Lawmakers advance bill to change how MedPAC studies spending
www.statnews.com/2026/09/16/m...
GOP aims to change Medicare adviser’s math so it's more favorable to health insurers
The GOP bill directs MedPAC to study the topic of overpayments to Medicare Advantage plans in a manner that’s more favorable to insurers.
www.statnews.com
September 25, 2026 at 2:53 AM
Private insurers have always benefited from favorable selection relative to traditional Medicare and because of inadequate risk adjustment (driven in large part by upcoding) that leads to overpayments. MedPAC has been estimating the size of the overpayments for many years, as have outside analysts.
Upcoding makes it look like insurers have a sicker patient pool, increasing their reimbursement under Medicare. But it's physically tapped in by doctors, many of whom work for insurers. It's also facilitated by an electronic medical records system dominated by 1 company:
prospect.org/health/2024-...
prospect.org/health/2024-...
December 7, 2024 at 4:57 PM
Upcoding makes it look like insurers have a sicker patient pool, increasing their reimbursement under Medicare. But it's physically tapped in by doctors, many of whom work for insurers. It's also facilitated by an electronic medical records system dominated by 1 company:
prospect.org/health/2024-...
prospect.org/health/2024-...
Senators see a crackdown on Medicare Advantage upcoding as a potential way to generate savings.
Senate GOP eyes Medicare Advantage reforms as a way to pay for tax cuts
Senators see a crackdown on Medicare Advantage upcoding as a potential way to generate savings.
buff.ly
June 6, 2025 at 2:32 PM
Senators see a crackdown on Medicare Advantage upcoding as a potential way to generate savings.
Has DOGE done anything to clamp down on the tens of billions lost due to upcoding by insurers in Medicare Part B? What about the excessive payments we make to drug companies? How about Donald Trump's golf outings?
March 19, 2025 at 7:33 PM
Has DOGE done anything to clamp down on the tens of billions lost due to upcoding by insurers in Medicare Part B? What about the excessive payments we make to drug companies? How about Donald Trump's golf outings?
The biggest part of Brian Thompson's job was running UHC's industry-leading plan for Medicare Advantage, a private Medicare insurance option that the government estimates is responsible for $100 billion in overpayments per year, done in part by UHC doctors upcoding
www.medpac.gov/document/mar...
www.medpac.gov/document/mar...
March 2024 Report to the Congress: Medicare Payment Policy – MedPACLock
www.medpac.gov
December 7, 2024 at 4:53 PM
The biggest part of Brian Thompson's job was running UHC's industry-leading plan for Medicare Advantage, a private Medicare insurance option that the government estimates is responsible for $100 billion in overpayments per year, done in part by UHC doctors upcoding
www.medpac.gov/document/mar...
www.medpac.gov/document/mar...
Maybe they confused upcoding with computer coding?
Or possibly they confused it with updog....
Or possibly they confused it with updog....
February 5, 2025 at 9:05 PM
Maybe they confused upcoding with computer coding?
Or possibly they confused it with updog....
Or possibly they confused it with updog....
We were finally starting to get some scrutiny on the upcoding and gaming of risk adjustment in Medicare Advantage, and now this
November 19, 2024 at 10:17 PM
We were finally starting to get some scrutiny on the upcoding and gaming of risk adjustment in Medicare Advantage, and now this
The real problem is over 90% of Medicaid fraud is committed by providers, not patients. Hospitals, clinics, and pharmaceutical companies are the ones overbilling, upcoding, and exploiting the system for profit. If you’re serious about fixing Medicaid, start where the real waste is.
June 8, 2025 at 3:22 PM
The real problem is over 90% of Medicaid fraud is committed by providers, not patients. Hospitals, clinics, and pharmaceutical companies are the ones overbilling, upcoding, and exploiting the system for profit. If you’re serious about fixing Medicaid, start where the real waste is.