Source: United States Senator for Massachusetts – Elizabeth Warren
March 14, 2025
Dr. Oz: “My goal is to improve the health care of the American people…[cutting Medicare Advantage fraud] sounds like a more rational way to do that [than cutting funding for Medicaid].”
The Medicare Payment Advisory Committee projects that CMS overpaid private insurers in MA by $83 billion in 2024 alone.
Video of Exchange (YouTube)
Washington, D.C. – At a hearing of the Senate Finance Committee, U.S. Senator Elizabeth Warren (D-Mass.) pressed Dr. Mehmet Oz, President Trump’s nominee for Administrator of the Centers for Medicare & Medicaid Services (CMS), on taxpayer fraud committed by private, for-profit insurers in the Medicare Advantage program.
The Medicare Payment Advisory Committee (MedPAC) projects that CMS will overpay private insurers in MA by $83 billion in 2024 alone, largely due to upcoding and favorable selection tactics by the insurers.
An investigation led by the Health and Human Services Inspector General (HHS OIG) revealed that private insurers in MA raked in about $4.2 billion in extra CMS payments in 2022 for diagnoses from home visits the companies initiated, even though they led to no treatment. The Wall Street Journal also found that between 2018 and 2021, private insurers in MA raked in $50 billion from CMS for diagnoses that led to no treatment.
Dr. Oz previously called the Traditional Medicare program “highly dysfunctional” and argued that private Medicaid Advantage insurers offer cheaper and more accessible coverage. He outlined a “Medicare Advantage for All” plan, which would move all non-Medicaid eligible Americans into MA. During this time, Dr. Oz held over $500,000 in stock with the largest private insurer in Massachusetts, UnitedHealth.
When questioned if he would rather cut waste, fraud, and abuse in Medicare Advantage, or cut funding for Medicaid during his confirmation hearing, Dr. Oz agreed that “the former sounds like a more rational way to do that.” Last month, Republicans in the House passed a spending bill with $88 billion in annual cuts to Medicaid.
Senator Warren has led strong oversight on Dr. Oz through his confirmation process and, ahead of his confirmation hearing, sent 176 questions demanding answers to his plan to eliminate traditional Medicare, his serious conflicts of interest, his dangerous anti-abortion views, and more.
Transcript: Hearing to examine the nomination of Mehmet Oz, of Pennsylvania, to be Administrator of the Centers for Medicare and Medicaid Services.
Senate Finance Committee
March 14, 2025
Senator Elizabeth Warren: Thank you, Mr. Chairman. So, Dr. Oz, if confirmed, you would oversee Medicare coverage for more than 66 million Americans. Nearly half have traditional Medicare, where the federal government provides health care coverage directly. The other half are on Medicare Advantage, where the federal government pays a private for-profit insurer to administer the health benefits instead. And surprise, surprise, the privatized Medicare costs a whole lot more.
So, let’s talk about the top trick that Medicare Advantage insurers use to gouge taxpayers up coding. I understand Senator Cassidy started on this this morning, and I just want to dig a little deeper in Medicare Advantage. Taxpayers give insurers a set amount per patient. The more diagnoses, or the more codes, the patient has, the higher the payment. Now, in theory, this covers higher costs for sicker patients, but insurance companies get the money for the codes, not actually for the services they do or don’t deliver.
Medicare Advantage insurers have figured out that if they can add a bunch of fake diagnoses that they don’t actually have to spend money treating, they can really boost their profits. One example, last year, the Wall Street Journal identified 66,000 Medicare Advantage patients diagnosed with diabetic cataracts who had already gotten cataract surgery. Now that is, as you know, anatomically impossible.
So, Dr. Oz, insurers pocketed an extra $178 million in taxpayer money last year thanks to just this one fake diagnosis. Does that sound like Medicare fraud to you?
Dr. Mehmet Oz: Senator Warren, I appreciate you spending time with me in your office. The answer is yes, anatomically impossible.
And I’ll give you one more example, okay, which is sending someone to your home, which you brought up in the office. If you’re going to say it, I won’t say it, but you pointed out something that’s very real, which is if you send someone to, someone to, if an insurance company sends someone to your home, there’s probably a reason for it. And so if they’re doing ultrasounds to look for minor atherosclerotic plaques, which is not really something that needs to be treated and most Americans have, it’s primarily done to upcode you. Which has two problems. One, it’s cheating, because you’re able to charge more for those patients. But then people who truly have limb-threatening peripheral vascular disease, who have that box checked in their care, those companies—insurance companies—don’t get paid more, those doctors don’t get reimbursed more for doing what is ethically correct. So it doesn’t just help the scoundrels who are stealing from the vulnerable, it’s actually hurting the people trying to take care of those vulnerable populations.
Senator Warren: In fact, let’s talk about how bad that upcoding is that comes from the home visits. HHS Inspector General found that in 2022 alone, United Health used these home visits to add about $2.3 billion worth of diagnoses, diagnoses that led to absolutely no treatment.
And I take it, you think that sounds like fraud, as well?
Dr. Oz: We are, I think, as an agency aware of this. I haven’t been in there yet, but if confirmed, this will be one of the topics that is relatively enjoyable to go after, because I think we have bipartisan support.
Senator Warren: I love hearing this. So, upcoding is a scandal, and overall, we know that Medicare Advantage overpayments cost at least $83 billion in a single year. So, $83 billion—remember that number. Last month, Republicans in the House passed a budget framework that sets up $88 billion in annual cuts to health care, Medicaid funding for seniors in nursing homes, and for people with disabilities who have a home health aide, and more.
Dr. Oz, I have a simple question: If you had the choice, would you rather cut waste, fraud and abuse by a Fortune 50 health insurance company in Medicare Advantage or cut funding for Medicaid, which covers half of all seniors in nursing homes and one in three of America’s children?
Dr. Oz: My goal is to improve the health care of the American people, and as you create the argument, the former sounds like a more rational way to do that.
Senator Warren: I appreciate that. You know, I am happy to work with Republicans to go after waste, fraud and abuse, but let’s cut out waste, fraud and abuse where it actually occurs, like upcoding in Medicare Advantage. Republicans cutting health care for seniors and for babies and for people with disabilities, while the waste and the fraud just roll right along for a multibillion-dollar insurance company is sickening, and I will fight that every step of the way. Thank you, Dr. Oz.