“The challenge is: Anything you do to tighten up risk adjustment can have an impact on the benefits that people get,” Chernew said. “The questions are: By how much, and which benefits are affected? Program integrity is an important goal, but I don’t think anybody wants to destroy the Medicare Advantage program.”
UnitedHealth Group, which runs UnitedHealthcare, the nation’s largest health insurer, has long defended the MA program and continues to do so.
“MA plans do a much better job of identifying and documenting health risks than traditional fee-for-service Medicare,” the company said in a December statement.
Insurers argue the large MA market share, which has built steadily over the past two decades, speaks to its popularity. It has been chosen by nearly 35 million seniors and individuals with disabilities nationwide, according to America’s Health Insurance Plans (AHIP), the trade group for health insurance companies.
At Tuesday’s congressional hearing, Doggett quoted the viral video of a Texas plastic surgeon who said a patient was on the operating table when a message arrived from UnitedHealthcare with a question on coverage for the procedure.
“Stories like hers are why I’ve asked the Justice Department to expand its investigation into United,” said Doggett.