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centers for medicare and medicaid services
Rampant Medicare Advantage Fraud Is Staring Musk in the Face. Critics Predict He'll Ignore It
"I'll bet Elon and the DOGE boys can't find Medicare Advantage," quipped one economist. "You know these people were not hired on merit."
Feb 06, 2025
Privatized Medicare Advantage plans overbill the U.S. federal government by up to $140 billion per year as they make patients appear sicker than they actually are to rake in more taxpayer money.
It didn't take a team of inexperienced engineers combing through the complex and sensitive inner workings of government payment systems to reach that conclusion, but that's reportedly what Elon Musk's lieutenants are now doing at the Centers for Medicare and Medicaid Services (CMS) with the stated goal of locating and combatting "fraud."
On Wednesday, The Wall Street Journalreported that representatives of the so-called "Department of Government Efficiency" (DOGE) have gained "access to key payment and contracting systems" at CMS with an eye toward "pinpointing what they consider fraud or waste."
Precisely what Musk and his lackeys see as fraud, and whether pervasive Medicare Advantage overbilling fits their definition, is unclear. In a post to his social media platform on Wednesday, Musk claimed—without elaborating or providing any evidence—that CMS is "where the big money fraud is happening."
But critics expressed doubt that Medicare Advantage, a huge cash cow for private insurers that's supported by President Donald Trump and congressional Republicans, will become a focal point of Musk's austerity blitz.
"You don't have to search payment systems for Medicare fraud, you could turn to the latest published report from the Medicare Payment Advisory Commission which helpfully lists $83 billion in annual fraud payments," The American Prospect's David Dayen wrote Wednesday. "The unnecessary overpayments are all made to private insurers in Medicare Advantage, the privatization of Medicare. We found the money!"
"Alternatively, if you're hunting for Medicare fraud you could go to the office of Senator Rick Scott," Dayen added, referring to the Florida Republican whose healthcare firm committed large-scale Medicare and Medicaid fraud.
Last month, Dayen noted that a crackdown on Medicare Advantage is "an unlikely avenue for DOGE" given that Mehmet Oz—who campaigned for the U.S. Senate on a plan dubbed "Medicare Advantage for All"—is poised to lead CMS.
Nor has Robert F. Kennedy Jr., who is on track for Senate confirmation to lead the department that oversees CMS, expressed any interest in tackling Medicare Advantage fraud. During his confirmation hearing last week, Kennedy failed to correctly answer basic questions about Medicare, including Medicare Part C—also known as Medicare Advantage.
Dean Baker, a senior economist at the Center for Economic and Policy Research, quipped Thursday that "I'll bet Elon and the DOGE boys can't find Medicare Advantage."
"You know these people were not hired on merit," he added.
In a blog post on Wednesday, Baker pushed back on the view that "Musk and his crew somehow want a world without government," writing that in reality they simply "don't want government social programs that help people who are not rich."
"Musk's view is that the government should only be there to make him and his fellow billionaires richer," Baker wrote. "We could have a much more efficient insurance system if we had Medicare for All, but that would wipe out the private insurance industry. Instead, we are going the other way and whittling down traditional Medicare and increasing costs by pushing people back to private insurers with Medicare Advantage."
"It is absurd that people on the left have allowed the Musk billionaire libertarians of the world to pretend they are anti-government," Baker added. "They just want a government that only serves their interest rather than society as a whole."
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Watchdog Says Dr. Oz Push for 'Medicare Advantage for All' Is Disqualifying
"Oz's deep ties to the private healthcare industry make his nomination to lead our nation's current healthcare system totally egregious," said Public Citizen healthcare advocate Eagan Kemp.
Dec 20, 2024
The watchdog group Public Citizen said Thursday that lawmakers should reject President-elect Donald Trump's nomination of Medicare privatization advocate Mehmet Oz to lead a key health agency and instead move toward a publicly run single-payer system that would cover all Americans at a lower cost than the status quo.
In a new brief, Public Citizen warned that Medicare privatization efforts—particularly via an expansion of Medicare Advantage plans run by for-profit insurance companies—would likely "move into overdrive" if the Senate confirms Oz as administrator of the Centers for Medicare and Medicaid Services (CMS).
Ahead of his 2022 Senate bid, Oz backed a plan he described as "Medicare Advantage for All," under which privately run plans would cover non-seniors and "all Americans who are not on Medicaid"—effectively eliminating traditional Medicare.
Public Citizen warned such a plan "would mean huge corporate profits while patients continue to struggle to get the healthcare they need," noting that Medicare Advantage plans are notorious for denying necessary care and overbilling the federal government to the tune of tens of billions of dollars per year.
"Policymakers should pass Medicare for All to guarantee care for everyone in the U.S., bring down costs for working families, and generate savings for the country as a whole."
"Further privatizing Medicare would increase healthcare costs systemwide by adding further administrative bloat to our healthcare system," the new brief argues. "Our healthcare system is already made up of thousands of health insurance plans offered by numerous insurers as well as state and federal programs that all play some role in paying for healthcare."
"By spending healthcare resources on corporate profit or administrative waste, privatized Medicare would mean Americans pay even more for healthcare than they already do," the brief adds. "We already spend far more than comparably wealthy countries, over $12,500 per capita, compared with peer nations that are spending around half, per capita."
Oz's plan would also benefit companies in which he has invested tens of millions of dollars, according to financial disclosures.
"Dr. Oz owned between $280,000 and $600,000 in shares in UnitedHealth Group, a major Medicare Advantage insurer, and between $50,000 and $100,000 in shares of CVS Health," Public Citizen noted Thursday, citing the filings.
Eagan Kemp, a healthcare advocate at Public Citizen, said in a statement that Oz's "Medicare Advantage for All" proposal "is dangerous to all patients, especially seniors and people with disabilities, many of whom have not received the care they need under Medicare Advantage."
"Healthcare is a right, not a commodity," said Kemp. "Oz's deep ties to the private healthcare industry make his nomination to lead our nation's current healthcare system totally egregious. Congress should reject Oz's nomination and any proposal to further privatize Medicare."
"Instead," he added, "policymakers should pass Medicare for All to guarantee care for everyone in the U.S., bring down costs for working families, and generate savings for the country as a whole."
Public Citizen's brief came as Oz's nomination faced increasingly close scrutiny from congressional Democrats, who have raised similar concerns about the former television personality's promotion of Medicare Advantage and ties to the private insurance industry.
"As CMS administrator, you would be tasked with overseeing Medicare and ensuring that the tens of millions of seniors that rely on the program receive the care they deserve, including cracking down on abuses by private insurers in Medicare Advantage," a group of Democratic lawmakers led by Sen. Elizabeth Warren (D-Mass.) wrote in a letter to Oz last week. "The consequences of failure on your part would be grave. Billions of federal healthcare dollars—and millions of lives—are at stake."
"Given your financial ties to private insurers, combined with your view that the traditional Medicare program is 'highly dysfunctional' and your advocacy for eliminating it entirely," the lawmakers added, "it is not clear that you are qualified for this critical job."
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Dr. Oz Had Up to Tens of Millions Invested in Companies Involved With CMS
"Seniors deserve a CMS leader who will protect and strengthen Medicare—not someone like Dr. Oz who wants to privatize this vital and hugely popular program for great personal gain," said the head of Accountable.US.
Dec 13, 2024
Dr. Mehmet Oz, the "former daytime television fixture" who U.S. President-elect Donald Trump picked to lead the Centers for Medicare and Medicaid Services, reported "up to $56 million in investments in three companies" with direct CMS interests, the watchdog Accountable.US highlighted Friday.
The celebrity heart surgeon is already under fire for his record of peddling "baseless or wrong" health advice and pushing Medicare Advantage (MA)—an alternative to the government-run program administered by private health insurance companies—on The Dr. Oz Show, as well as his stake in UnitedHealth and CVS Health.
The new Accountable.US report—based on disclosures from Oz's unsuccessful 2022 run against U.S. Sen. John Fetterman (D-Pa.)—adds to conflict of interest concerns and fears that Oz may thwart the Biden administration's new rule intended to rein in privatized Medicare Advantage plans.
"Dr. Oz's conflicts of interest pose a serious threat to seniors' health security."
"In 2022, Oz's 'single biggest healthcare holding' was up to $26 million in Sharecare, a digital health company Oz co-founded that became the 'exclusive in-home care supplemental benefit program' for 1.5 million MA enrollees across 400 MA plans through its CareLinx service in 2022," the watchdog detailed. "By 2023, CareLinx was available to over 2 million MA enrollees. Sharecare was taken private in a $518 million private equity deal in 2024, and it is unknown if Oz still holds a stake."
Nick Clemens, Oz's spokesperson on the Trump transition team, told USA TODAY—which first reported on the Accountable.US findings—that Oz sold his stake in Sharecare but did not address further questions.
The group noted that "in 2022, Oz disclosed holding up to $25 million in Amazon and up to $5 million in Microsoft, which CMS called its 'two primary cloud service providers' in its FY 2025 budget document, which requested over $3.3 billion in information technology funding for the year. Notably, Amazon Web Services hosted 74 million Medicaid records as early as 2017 and the company has been contracted to streamline Healthcare.gov, the federal health insurance portal run by CMS."
Accountable.US "reviewed filings with the Securities and Exchange Commission and was unable to find evidence that Oz sold stocks in Amazon or Microsoft since the 2022 filing," according to USA Today—which found that Oz's stakes could be as high as $26.7 million for Amazon and $6.3 million for Microsoft.
When asked if Oz still owned the stocks in the two tech giants, Trump transition spokesperson Brian Hughes only said that "all nominees and appointees will comply with the ethical obligations of their respective agencies."
Given the nominee's TV and investment history, Accountable.US executive director Tony Carrk declared Friday that "seniors deserve a CMS leader who will protect and strengthen Medicare—not someone like Dr. Oz who wants to privatize this vital and hugely popular program for great personal gain."
"If Dr. Oz and Project 2025 had their way, Medicare as we know it would end, replaced with private insurance plans that cost taxpayers more and leave patients vulnerable to denials of care and higher premiums," Carrk continued, citing the Heritage Foundation-led playbook for the incoming Republican president.
"Dr. Oz's conflicts of interest pose a serious threat to seniors' health security," he added, "but as long as big insurance industry megadonors are happy, President-elect Trump doesn't seem to mind."
While Trump has the power to pick the next CMS administrator, the selection requires Senate confirmation—unless the president-elect works around it to install his most controversial nominees.
On Tuesday, Sen. Elizabeth Warren (D-Mass.) and six colleagues wrote to Oz to express their concerns about his qualifications, "advocacy for the elimination of traditional Medicare," and "deep financial ties to private health insurers."
"As CMS administrator, you would be tasked with overseeing Medicare and ensuring that the tens of millions of seniors that rely on the program receive the care they deserve, including cracking down on abuses by private insurers in Medicare Advantage," they pointed out. "The consequences of failure on your part would be grave. Billions of federal healthcare dollars—and millions of lives—are at stake."
The lawmakers sent Oz a list of questions, requesting responses by December 23. They inquired about his views on traditional Medicare and revelations that "private companies overcharge taxpayers and unlawfully deny care." They also asked whether, as administrator, he would commit to "fully divesting of any and all financial holdings related to the insurance industry" and "recusing from any decisions that may impact insurers" in which he has a stake.
Sharing the letter on social media Wednesday, Accountable.US said that Warren "is right: this glaring conflict of interest endangers seniors and puts billions in corporate pockets."
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