Polls show Americans are angry – and rightly so – at accelerating medical bills. Meanwhile, the insurers and hospitals keep raking in record profits.
UnitedHealthcare just reported jumbo profits so far in 2026, and in 2025, they recorded revenues of more than $400 billion. They are raking in profits from the $1.9 trillion in federal healthcare programs.
Two of the largest “nonprofit” hospital chains, Kaiser Permanente and HCA Healthcare, recorded nearly $200 billion in assets at the end of 2024. As Rep. Jason Smith, chairman of the House Ways and Means Committee, put it: “Hospitals are charging an insane amount. Hospital prices have skyrocketed 300% in just over two decades – more than any other sector of our economy.”
A major driver of costs is the fraudulent claims paid out by the government to health insurers and hospitals. Much of the scam billings are charged to the half-trillion-dollar Medicare Advantage program.
Here’s one way they get away with it.
Medicare payments are based on a patient’s risk factors or diagnosed conditions – not payments for actual healthcare services. Medicare Advantage enrollees are healthier on average than traditional Medicare beneficiaries, yet insurers consistently inflate patient risk scores so they can bilk more money from Uncle Sam.
This scheme is known as “upcoding.” By exaggerating the patients’ health problems, insurers collect larger payments from the government without providing additional healthcare. It’s the healthcare equivalent of a driver filing an insurance claim for a fender-bender and seeking reimbursement for much more than the repairs actually cost.
The Medicare Advantage program is supposed to be a free-market supplement to Medicare. But the rules are written as if to fatten the wallets of the hospital and insurance giants — while the taxpayers and employers eat the costs.
Some of my Republican friends argue that Medicare Advantage is a free-market insurance program. Really?
The GOP’s Doctors Caucus – people who treat patients firsthand – has increasingly warned that insurers are extracting billions in payments that bear no relation to patients’ actual medical needs.
The Trump administration is finally ending this blank-check billing scheme. In January, the administration stunned Medicare Advantage insurers by rejecting a “big boost” in payments. Instead, President Donald Trump wants reforms to root out “upcoding” fraud that pads insurers’ profits.
Here’s another commonsense way to save money on healthcare. Trump’s Centers for Medicare & Medicaid Services has proposed excluding diagnoses added by an insurer who merely reviews patient records but never actually sees the patient. CMS projects that eliminating such diagnoses would save taxpayers some $7 billion next year alone.
One piece of good news is that some states are auditing hospital billing practices. Indiana’s House just unanimously passed the “payment of health claims” law pushed by Gov. Mike Braun that will root out phony reimbursement scams.
States like Arkansas, Virginia, and Ohio are now following Indiana’s lead, and Congress should, too.
The savings impact of reining in Medicare Advantage fraud reaches into the high tens of billions of dollars every year – money that is effectively stolen from taxpayers and employers. Medicare Advantage is now covering more than half of American seniors.
For too long, fraudulent medical care billing has been treated like a ho-hum cost of doing business in Washington and state capitals. It isn’t. It’s theft. The victims are patients, employers, doctors, and taxpayers.
Trump and Braun should be applauded for demanding that private insurance companies stop bilking taxpayers. If insurers and hospitals keep getting rich by cheating, they should be thrown out of the program.
Stephen Moore is a former Trump senior economic adviser and the cofounder of Unleash Prosperity, which advocates for education freedom for all children.
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(As posted on another article addressing the fraud issue)
Fraud, fraud and more fraud.
Talk, talk and more talk.
Where are the arrest?
Where are the indictments?
Where are the prison sentences?
Where are the deportations?
Where are the reparations?
Why are so many crooked politicians and corrupt judges still in office?
No wonder “healthcare” costs are exorbitant.
(and this is just the tip of the proverbial iceberg)
The flip side of this equation is, how many of us had legitimate health insurance claims denied and it’s a constant fight to get these providers to pay bills?
Bingo. I trust nothing about Big Med, Big Pharma, or Big Insurance. Massive steal.
Insurance companies got rich after the “Unaffordable Care Act” was passed.
Why is it, do you think, when honest and hard working ‘Murican citizens submit insurance claims, the insurance man finds all sorts of reasons to DENY those claims. But if a crooked organization submits buttloads of fake claims, those sail right thru?
No wonder ‘Murica is going broke. FJB, and all of his ilk.
Why are health care costs all over the map? Every medical profession charges whatever they want or in reality whatever they can get away with. Of course health care profession isn’t limited to doctors, nurses or administrators, the tentacles go far beyond them. Pharmaceutical companies, medical suppliers and durable goods providers all have a hidden connection with the higher ups playing god and deciding who or who does not gets care. Hospitals are definitely for profit even if they claim non profit status. Millionaire compensation is probably the norm and rightfully deserved, however the bottom line is keeping share holders happy and it comes before expensive treatments that cut into their bottom line. If there is fraud and most likely there is, it’s usually the bean counters behind the curtain. My premiums and co-pays always go up, the amount is unpredictable as the weather.
One of the bigger issues is that insurance companies along with other big corporations lobby Congress all the time to include statements or line items in upcoming legislation that benefit those corporations. Lobbyists entice votes with high-price gifts, trips and promises of future employment.
Buying votes for their companies is the sole reason I’ve said lobbying in Congress should be outlawed BUT they would no doubt find another, more private way to do the same thing, because it works.
Then there is the fact that some members of Congress evidently have no scruples about taking those bribes; after all they convince themselves what they’re being asked to do isn’t that bad.
Having worked for BCBS for over 20 years, it’s not the doctors that make the rules but the insurance companies. I understand needing (some) documentation, and even though they employed a physician who knew about procedures,he still worked for the insurance company. So, that’s why they wanted all kinds of documentation and why they denied some things. Yes, you have to be careful of fraud, but who knows better what the patient needs than their physician? I use to tell people don’t blame the costs of things on the doctor but blame it on the insurance companies. Sadly, physicians were held back and under the control of the insurance companies.
Important article Mr.Moore – the sort of corruption described in this article needs to have attention given to it. Ethics needs to be thought of every step of the way on the journey to establishing a non-corrupt system. Your writing on this topic is is appreciated Stephan
I understand about fraud but I am not sure about uploading it what is meant by it.
all I know is I have 4 different cancers and see 4 different specialists plus a family doctor.
i have a colostomy I got in 2019 and am on a specialized medicine which is keeping me alive. A foundation is helping me pay for the medicine which is 2500 per month. I visit an oncologist every 3 months and as long as bloodwork is ok I don’t have anymore tests. I have an MRI/CT scan every year. Same exact thing. Last year my copay was 295.00, this year it’s 400.00 and they found more cancer so I had to have a colonoscopy which is another 400. I see no fraud there – but I do see a lot of wasting it’s more with rules and regulations. In the process of just learning of this do you know how many bodies you have to deal with besides the insurance people and the accounting people at the hospital. And then there are random people who check up on people. The only fraud I see is the radonm companies who sell their services to insurance companies who really are duplications to what the hospital , doctor or patient is already doing. I honestly don’t know how the hospitals or doctors make any money with the number of people I have interacted with. All I know is since Feb 14 2026. I have interacted with at least 30 health professionals and then there is hospital staff which keeps everything running , then there is the back end accounting side. And it’s 4/29/2026 and I still don’t have a firm plan of treatment . But I have a diagnosis. I HAVE ANOTHER CANCER. Where is the fraud?
How did it happen, that we became a pawn on the chess board, why can’t I have the insurance for emergencies only and pay as I go for any other purposes, which are very few fortunately,. Perhaps that would force people to take responsibility for their own well being, they would have to make adjustment in the life style. I realize there are situations that people have no control over and med. intervention is necessary, but majority are victims of their own unhealthy life style and habits, make them pay for the visits and see how grudgingly but out necessity they change. Stop feeding the kids deep fried sugared garbage and supersized sugary drinks, get them off the electronics.
Another reason to thank President Trump.
It is very upsetting to know that there are enough evil people among us who think stealing money from others is okay. I am glad that this administration is taking on this issue. Governor Walz of MN was seen on Fox News bragging that he made sure the 9 BILLION dollar fraud in his was getting attention. He is such a lying s.o.b. How in the world do people vote on such despicable characters to run their state? (Or maybe all of the Democrat/Commie nominees lack morals). He looked the other way every time it was brought to his attention and I would be willing to bet he was getting a kickback. It was his job to know what was going on in HIS state!
I think genetics plays a big role in our long term health, no matter how carefully you eat or exercise, or do anything else to help yourself. You may slow down the effects of genetics by taking better care of yourself, but personally, I don’t believe that you can completely negate the effects of genetics over time.
Where is Congress? In the campaign donation line. We get no permanent relief until Congress functions. Trump is trying to move mountains but he is stuck with executive actions and that will last until the next Dem takes the WH. Meanwhile Congress runs around pointing fingers but doing nothing,
Well, it’s a known fact that the pharmaceutical companies WANT you to be sick so they can make money on you, then they feed you food to help make you sick, that’s why I can never understand why the FOOD AND DRUG Administration is combined…makes it too easy !!
If we just ate right and did a little more exercise, every day, just think of the savings. I only use Medicare for a few tests and visits a year at 70 because I act responsibly with my health. Imagine if more people would follow suit how much better off we would be. A lot of hospitals would go bankrupt.
When your medical insurance company wants to send someone to your home to do a “checkup”, say NO. They want to get between you and your doctor and add diagnosis codes to your medical records which will increase their Medicare reimbursement. Down the line, that could impact your ability to get other insurance.
Why, I’m flummoxed, totally perplexed. Fraud? My goodness. Whoda thought
This is right out of Animal House “Ya #@&*’d up, ya trusted us.
And insurance companies!
Kaiser Permanente of Southern California was just charged with embezzling 447 Million from Medicare Senior Advantage .