Media Tip Sheet: Report Shows Insurances are Pocketing Millions from Medicare on Diseases Not Treated by Doctors

July 9, 2024

WASHINGTON (July 9, 2024) - Insurers have been taking billions of dollars from Medicare Advantage for diagnosis that doctors didn’t treat. 

Medicare gives insurers the option to add diagnosis to patients that reportedly doctors often neglect to document, which has led to an increase in diagnoses from home visits that were not certified or signed by a doctor. 

Because of the way that Medicare pays insurers, there’s an advantage to insurance companies who report more diagnosis.  The Wall Street Journal reported that “Medicare Advantage is a $450-billion-a-year system in which private insurers oversee Medicare benefits.” 

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Barak Richman is the Alexander Hamilton Professor of Business Law at the George Washington University Law School. Richman is an expert in healthcare policy, new institutional economics, antitrust, and economics of contracting. In 2006, he co-edited a symposium volume of Law and Contemporary Problems titled, “Who Pays? Who Benefits? Distributional Issues in Health Care” 


Richard Ricciardi is an associate dean for Clinical Practice and Community Engagement in the GW School of Nursing and the executive director for the Center for Health Policy and Media Engagement at GW.

Jeffrey Levi is a professor of health policy and management at the GW Milken Institute School of Public Health. His work focuses on the intersection of public health, the health care system and the multi-sector collaborations required to improve health.