Connecting the Dots: Latest insurance fraud shows nothing has changed in half a century

  • Graphic by Tomi Ungerer that accompanied John Bos’s letter to the editor “Dollar in Need of Demolition” in The New York Times on April 18, 1972 TOMI UNGERER/THE NEW YORK TIMES/CONTRIBUTED BY JOHN BOS

  • John Bos FILE PHOTO

Published: 10/16/2022 5:57:48 PM

Reading it made me sick. And tired. And angry.

Did you ever read anything that made you sick to your stomach? I did last Sunday … when I read a front-page article in The New York Times with the headline “How Insurance Firms Exploited Medicare Advantage for Billions.” It made me sick, And tired. And angry.

Sick because we are living a society overcome with debt and death. The most recent numbers should make anyone sick. Alongside growing debt, U.S. life expectancy has stagnated for two decades and in 2015 it actually began to drop in a way unseen in modern history. Sick and angry because our country’s disastrous response to the COVID-19 pandemic only accelerated this trend and revealed systemic failure in our health care system. The same health care “system” that enriched the nation’s health care and insurance corporations. Sick because connected to the issue of our lowered life expectancy is the growing crisis of what some call “deaths of despair” — from suicide, drug overdose and alcoholism. Angry because U.S. debt has reached new heights, including $1.6 trillion in student debt, up 100% since 2010.

Tired because in The New York Times 50 years ago my letter to the editor ended with this now-sophomoric plea “What is needed is a devaluation of the dollar in everyone’s value system which, of course, demands an inflation of our regard and concern for fellow beings.” Angry because nothing has changed in half a century.

The Oct. 9 NYT review of dozens of Medicare Advantage fraud lawsuits, inspector general audits and investigations by watchdogs described how major health insurers exploited this program to inflate their profits by billions of dollars.

Medicare Advantage, the private-sector alternative to traditional Medicare, “was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost” according to the Times. However, it is now revealed that eight of the 10 biggest Medicare Advantage insurers representing more than two thirds of the market “have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to over diagnose their customers crossed the line into fraud,” the Times reported.

These “additional diagnoses” led to $12 billion in overpayments in 2020 alone according to an estimate from the group that advises Medicare on payment policies, “enough to cover hearing and vision care for every American over 65, according to the Times. Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.”

Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But, as reported in the Times, “its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to one lawsuit. ‘The cash monster was insatiable,’ said Dr. James Taylor, a former coding expert at Kaiser who is one of 10 whistleblowers to accuse the organization of fraud. At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. ‘It was an actual agenda item’ Dr. Taylor said.”

This is all taking place in a time of bitter partisan divide and existential threat. A time described by President Biden as a “battle for the soul of this nation.” After the tumult of the Trump years, more Americans see civil war as a real possibility. Social scientists have noted that a cerebral distaste for contrary ideas has been supplanted among many American voters by a hatred for the people who hold those ideas. Things seem to be falling apart, and yet, within the corporate sector, the center holds just fine. The dollar rules over all else.

Megan K. Stack, in a scorching essay in the Times on Oct. 5, describes how both Republican and Democratic former administration officials find themselves working collaboratively in highly lucrative positions for Washington law and lobbying firms.

“None of this is particularly remarkable here in Washington,” Ms. Stack writes, “where government officials have long been traipsing over the crumbled walls separating them from the industries they regulate and investigate. The city is crowded with bureaucrats who are desensitized by ambition and quick to dismiss it all as no big deal.” Makes me angry.

So, I ask you: Do you think we can ever hope for “a devaluation of the dollar in everyone’s value system” which would lead to “an inflation of our regard and concern for fellow beings?”

Connecting the Dots is published every other Saturday in the Recorder. John Bos is a contributing writer for Green Energy Times. A copy of the Oct. 9 Megan Stack NYT op-ed “Where Are They Now? Trump Administration Edition” is available by request at


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