The Journal.

Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

114 snips
Jun 6, 2025
Christopher Weaver, an investigative reporter at The Wall Street Journal, dives deep into the troubling practices of Medicare Advantage. He reveals how private insurers exploit the system for profit, often leading to questionable and sometimes dangerous diagnoses. With insights from a nurse practitioner, they discuss the ethical dilemmas and financial motivations behind overdiagnosing patients. Their investigation uncovers shocking instances of patients being reported with severe illnesses without proper follow-up care, raising serious concerns about patient safety and care accessibility.
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INSIGHT

Insurers Inflate Diagnoses for Profit

  • Medicare Advantage insurers inflated patient diagnoses to earn billions more from government payments.
  • The program financially incentivizes showing patients as sicker on paper to increase lump sum payments.
ANECDOTE

Nurse Practitioner Pressured to Diagnose

  • Kristen Bell, a nurse practitioner at UnitedHealth, shared her experience of being pressured to order unnecessary tests.
  • She was encouraged to list diagnoses on charts that did not match patient symptoms to boost payments.
INSIGHT

Questionable Diagnoses Inflate Payments

  • Insurers added dubious diagnoses like diabetic cataracts extensively, which triggered high extra payments.
  • Patterns showed thousands diagnosed had no treatment or even lacked proper symptoms for these rare conditions.
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