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Medicare has been paying about 16% more for laboratory services than private insurers. That needs to change. CMS plans to better align 2027 laboratory payment rates with private-sector rates — which would be estimated to save taxpayers over $1 BILLION annually once the reductions are fully phased in, lowering... show more

Dr. Oz CMS

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40,616 views • 2 days ago •via X (Twitter)

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33 Comments

Dr. Gripesalot2 days ago

Unfucking believable what bullshit this is-using weight to skew the averages. We submitted two page response online. Just like everything @CMSGov does this will put independent labs out of business-now hospitals will charge everybody 20X instead of 5-10x. How are u this corrupt?

Laffincrow2 days ago

Quit using hospitals for outpatient lab services! Its the facility fee already.😏

Tami_Earls2 days ago

I get monthly prescriptions and I'm saying this loud and clear. MY MONTHLY PRESCRIPTIONS ARE DOWN. THANK YOU PRESIDENT TRUMP AND DR. OZ. 🕊️♥️🇺🇸

mrxmsa2 days ago

Some Medicare/Medicaid patients have 2-3 Wheelchairs and Hospital beds. Add to that Diabetes supplies (blood sugar monitors, test strips, and lancet devices) are sold on EBay and similar site. Time to stop waste!

Ginger Coleman2 days ago

Prescriptions down. BUT, insurance companies are upping the out of pocket deductibles and copays on almost every thing. That’s not helping at all. I know this because I just received my 2027 handbook 2 days ago!

Curtis Colbert2 days ago

$1B is a rounding error for Medicare. Fraud, waste, and abuse would be a much better target and a hell of a lot easier to execute.

Chad Massey2 days ago

Standardized Costs. Each individual shouldn't be charged a different amount. It should be the same across the board.

UFHealth Whistleblower Kathleen Maynard 🇵🇸Ⓥ2 days ago

We just want the same healthcare coverage that the Trump Administration and Congress have.

USA_Infidel2 days ago

Obamacare is a scam!

Dan Johnson2 days ago

Do 'durable medical equipment' next!!

Gallut2 days ago

Thank you Dr. Oz for all your work!

DSDill2 days ago

Thank you

Peace2 days ago

You know, Dr. OZ, if americans wanted to end their Medicare health insurance, this should not affect their Social Security benifits, but sadly it does. Can you fix that? @DrOzCMS

4thQT2 days ago

CMS plans to decrease payments to doctors for HIP AND KNEE replacements in 2027. THAT IS JUST WRONG!

CuriousJulie1012 days ago

Thank you! 🫡 Americans are proud to have you work for us.

RR2 days ago

Great to see the government benchmarking its costs! Keep it up Dr Oz and team!

Semper Fi 🪖2 days ago

💯

Ray2 days ago

@lawdawgseven @GOP @HHSGov

TruthSeeker242 days ago

The LA County needs a tighter tether to expenditures for labs. It’s ridiculous how they bill and repeatedly write these orders for unnecessary labs

Dylan2 days ago

I voted for spiritual surgery on America!! Amen! 🇺🇸

inheritancehouseflip2 days ago

Yeah you keep testing everybody for all these different things like drugs. Like not trusting patients. Most patients just want to heal. We don't want to go through your whole complete system because Medicaid sucks. Can you wait 3 months for angioplasty and shunt in existing stent to get unclogged? If the medical system fails in America. you should be giving Medicaid money to patients that can prove that they're going to go out of the country and get a procedure done. that they need immediately versus using the emergency room model! You could probably send Medicaid patients down to some private hospitals in Mexico and other countries save a lot of money help a lot of people really fast. Like me dude

SimpleSpace2 days ago

There is a reason we target any federal billing system or contract we can, it overpays Think of who works at these offices (not you) but the day to day staff we would write SOPs that tricked them to thinking the cost of something was 400% higher, so they would just pay blindly

Angelia2 days ago

GO TO HELL OZ! You and Trump do not give a damn about seniors!!

rick2 days ago

Yeah!

Curious Kat2 days ago

Very good!

YJZ2 days ago

Doctors' pay for annual patient care should increase. Physician-owned hospitals should not be held hostage by votes of hospitals in area; there should be no restrictions, if qualified physicians (US system).

magamanvegas2 days ago

they're all sociopathic criminals.

Leslie2 days ago

Once again harming small hospitals.

JennsInquisitive2 days ago

Whaa? Are you working on behalf of big healthcare payers? Dr Oz, we really don't want Medicare Advantage for all.

Fishngonzo2 days ago

Thank you Sir!

David Davis2 days ago

👍

iLuvIdaho2 days ago

When are you pulling the unsafe and ineffective covid vaccines off the market?

AmericanWoman_USA2 days ago

Can we have Medicare and private health insurance cover actual hearing aids for US citizens? 🦻🏻

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Every dollar lost to fraud is money that could be spent helping to make healthcare more affordable for Americans who need it most. We estimate that Medicare fraud costs taxpayers more than $100 BILLION. Eliminating that fraud would help extend the financial life of the Medicare program, protecting it for current and future beneficiaries.

Every dollar lost to fraud is money that could be spent helping to make healthcare more affordable for Americans who need it most. We estimate that Medicare fraud costs taxpayers more than $100 BILLION. Eliminating that fraud would help extend the financial life of the Medicare program, protecting it for current and future beneficiaries.

Dr. Oz CMS

52,238 views • 2 months ago

Pharmacy Benefits Managers are SKYROCKETING the price of prescriptions to Medicare because taxpayers are paying for it. This is a racket - Medication Chlorpromazine cost to Medicare is $344 per prescription - Normal price ONLY $17 - Medicare PAYS 20x THE PRICE - Medicare paid for this prescription 500,000 times and spent $170 million in 2022 - Of the $170 million that Medicare spent 165 million of that was wasted overpaying “The companies they hire to manage their pharmacy costs are so terrible at their job that 95% of the money they spent is wasted. If you're wondering how they could mismanage it this badly, it's because they get paid more. If the drugs cost more and worse, they own the pharmacies that most of these are filled at. That means that the ridiculous 95% waste goes straight into the pockets of the company tasked with lowering the costs.” This is a racket

Pharmacy Benefits Managers are SKYROCKETING the price of prescriptions to Medicare because taxpayers are paying for it. This is a racket - Medication Chlorpromazine cost to Medicare is $344 per prescription - Normal price ONLY $17 - Medicare PAYS 20x THE PRICE - Medicare paid for this prescription 500,000 times and spent $170 million in 2022 - Of the $170 million that Medicare spent 165 million of that was wasted overpaying “The companies they hire to manage their pharmacy costs are so terrible at their job that 95% of the money they spent is wasted. If you're wondering how they could mismanage it this badly, it's because they get paid more. If the drugs cost more and worse, they own the pharmacies that most of these are filled at. That means that the ridiculous 95% waste goes straight into the pockets of the company tasked with lowering the costs.” This is a racket

Wall Street Apes

84,879 views • 1 year ago

.Hakeem Jeffries is being dishonest about healthcare Martha MacCallum: 1. We tried bipartisan reforms under Biden to stop $100s of billions in Medicare overbilling by hospital cartels he & Chuck Schumer blocked. 2. We did NOT cut Medicaid benefits. On the contrary — we stopped $100s of billions in Medicaid money laundering by insurance & hospital cartels billing the feds at private rates (up to 3x Medicare) while cutting care for patients. 3. We are willing to help people on Obamacare — but we cannot keep funding insurance cartels that defraud taxpayers.

.Hakeem Jeffries is being dishonest about healthcare Martha MacCallum: 1. We tried bipartisan reforms under Biden to stop $100s of billions in Medicare overbilling by hospital cartels he & Chuck Schumer blocked. 2. We did NOT cut Medicaid benefits. On the contrary — we stopped $100s of billions in Medicaid money laundering by insurance & hospital cartels billing the feds at private rates (up to 3x Medicare) while cutting care for patients. 3. We are willing to help people on Obamacare — but we cannot keep funding insurance cartels that defraud taxpayers.

Rep. Victoria Spartz

17,148 views • 7 months ago

Labor and the Liberals are making more empty promises and reckless bribes that will break the bank. Remember when Albanese promised your power bills would drop by $275? That never happened. Now they want you to believe throwing another $8.5 billion at Medicare will fix the system. It won’t. The truth is, billions are already being wasted on fraud, rorts, and mismanagement. Up to $3 billion a year is lost to Medicare fraud. Bulk billing is collapsing. Out-of-pocket costs keep rising. GP clinics are struggling to stay open because of soaring costs driven by Labor’s bad policies. One Nation has a real plan to fix Medicare. We will: - Stop the rorts by introducing mandatory photo ID for Medicare cards - Crack down on fraud so the money goes to patients, not scammers - Increase Medicare rebates to support GPs and bring back bulk billing - Make healthcare affordable by cutting government waste Labor and the Liberals are only promising to buy votes with money we don’t have. One Nation will fix the system and put Australians first.

Labor and the Liberals are making more empty promises and reckless bribes that will break the bank. Remember when Albanese promised your power bills would drop by $275? That never happened. Now they want you to believe throwing another $8.5 billion at Medicare will fix the system. It won’t. The truth is, billions are already being wasted on fraud, rorts, and mismanagement. Up to $3 billion a year is lost to Medicare fraud. Bulk billing is collapsing. Out-of-pocket costs keep rising. GP clinics are struggling to stay open because of soaring costs driven by Labor’s bad policies. One Nation has a real plan to fix Medicare. We will: - Stop the rorts by introducing mandatory photo ID for Medicare cards - Crack down on fraud so the money goes to patients, not scammers - Increase Medicare rebates to support GPs and bring back bulk billing - Make healthcare affordable by cutting government waste Labor and the Liberals are only promising to buy votes with money we don’t have. One Nation will fix the system and put Australians first.

Pauline Hanson 🇦🇺

27,746 views • 1 year ago

🚨 RFK JR. JUST DROPPED A $100 BILLION BOMB. Medicare fraud. Over $100 BILLION stolen every year. Florida: more “medical equipment” companies than McDonald’s. Most of them had a patient number and a billing machine. When they got caught? Owners ran to Cuba. California: THOUSANDS of fake hospices. No real patients. Just bills. How they caught them: Hospice means you’ve got about 3 months to live. These “patients” never died. We’ve been paying $6,000 a month… for years. Dr. Oz says killing that fraud DOUBLES the life of the Medicare trust fund. This isn’t waste. This is a heist.

🚨 RFK JR. JUST DROPPED A $100 BILLION BOMB. Medicare fraud. Over $100 BILLION stolen every year. Florida: more “medical equipment” companies than McDonald’s. Most of them had a patient number and a billing machine. When they got caught? Owners ran to Cuba. California: THOUSANDS of fake hospices. No real patients. Just bills. How they caught them: Hospice means you’ve got about 3 months to live. These “patients” never died. We’ve been paying $6,000 a month… for years. Dr. Oz says killing that fraud DOUBLES the life of the Medicare trust fund. This isn’t waste. This is a heist.

Gunther Eagleman™

62,496 views • 25 days ago

🚨 To Elon Musk and the DOGE team looking at Medicare: Pharmacist says - Cancer Medicine Imatinib costs them $7 to buy. They add $10, so you're out the door for $17 - When Medicare pays for this drug, IT COSTS THEM $2,400 - This drug was filled 250,000 times in 1 year costing Medicare $600 million “If every one of those scripts was filled at our pharmacy instead of through Medicare, it would've cost $4 million. That means that we are $596 million cheaper than the insurance. That's crazy.” “So why are they paying this much for that medication? Well, insurance companies pay a middleman, the pharmacy benefits manager, and that person decides how much that medication's gonna cost” - 3 Pharmacy Benefits Managers control over 90% of all prescription pricing in America - Pharmaceutical companies bought all 3 Pharmacy Benefits Managers They set their own pricing, Medicare pays ASTRONOMICAL prices and taxpayers pick up the bill. This is a racket.

🚨 To Elon Musk and the DOGE team looking at Medicare: Pharmacist says - Cancer Medicine Imatinib costs them $7 to buy. They add $10, so you're out the door for $17 - When Medicare pays for this drug, IT COSTS THEM $2,400 - This drug was filled 250,000 times in 1 year costing Medicare $600 million “If every one of those scripts was filled at our pharmacy instead of through Medicare, it would've cost $4 million. That means that we are $596 million cheaper than the insurance. That's crazy.” “So why are they paying this much for that medication? Well, insurance companies pay a middleman, the pharmacy benefits manager, and that person decides how much that medication's gonna cost” - 3 Pharmacy Benefits Managers control over 90% of all prescription pricing in America - Pharmaceutical companies bought all 3 Pharmacy Benefits Managers They set their own pricing, Medicare pays ASTRONOMICAL prices and taxpayers pick up the bill. This is a racket.

Wall Street Apes

3,764,193 views • 1 year ago

Insurers take a cut of every premium dollar for overhead and profit. The question isn’t just whether they profit, but also whether we’re getting value in return. KFF’s Larry Levitt breaks down how much goes to administrative costs and profit and how that varies across private insurance markets and Medicare, and considers what a Medicare-for-all system, which would be operated by the government, would address and what might be left unresolved. 🎥 Watch more videos from our series, “Are Health Insurers to Blame for Our Health System Problems?” on This video was scripted and produced by KFF. Visuals and graphics were developed using Adobe Creative Cloud with assistance from AI tools and refined by a graphic designer.

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KFF

14,614 views • 6 days ago

Funny dynamic during Pod Save interview with Seth Moulton: Jon Favs asks Moulton if he is more moderate than Ed Markey. Moulton, someone defensively, says no— he’s also progressive and there’s very little daylight between them on policy. Jon argues that Moulton would do better to identify as a moderate bc some moderate policies are more popular, like a public option vs Medicare for all. Moulton goes on to agree on that policy point, saying that Medicare for all who wants it is better policy and more likely to get done. Moulton seems to understand that it’s better to be seen as a progressive, and is trying to downplay where he’s more moderate than Markey, but Jon is still stuck in a 2008 triangulation mindset, and wants Moulton to brag about his centrism. He is also still refusing to acknowledge that “Medicare for all who wants it” is incompatible with Moulton’s claim that he believes health care is a human right.

Funny dynamic during Pod Save interview with Seth Moulton: Jon Favs asks Moulton if he is more moderate than Ed Markey. Moulton, someone defensively, says no— he’s also progressive and there’s very little daylight between them on policy. Jon argues that Moulton would do better to identify as a moderate bc some moderate policies are more popular, like a public option vs Medicare for all. Moulton goes on to agree on that policy point, saying that Medicare for all who wants it is better policy and more likely to get done. Moulton seems to understand that it’s better to be seen as a progressive, and is trying to downplay where he’s more moderate than Markey, but Jon is still stuck in a 2008 triangulation mindset, and wants Moulton to brag about his centrism. He is also still refusing to acknowledge that “Medicare for all who wants it” is incompatible with Moulton’s claim that he believes health care is a human right.

Briahna Joy Gray

19,965 views • 29 days ago

WOW 🚨 Michigan Senate candidate Abdul El-Sayed is a Socialist but he’s RICH!! Tax filings show El-Sayed's household earned more than $686,000 in 2025, that’s nearly 10x Michigan's median household income Just like Bernie Sanders, he’s a rich hypocrite “One reason the Medicare for All candidate is raking in cash and backlash is that his wife, a psychiatrist, does not accept Medicare, or any other insurance plan at her practice” Wait just one second…. So his wife is denying cheaper taxpayers funded patients with negotiated government rates and instead only accepts the most profitable patients made possible through our capitalist Big Health Insurance industry??? For those who don’t understand the math here, she’s denying low income patients to make 2-3x+ more per patient with private insurance A psychiatrist that accepts Medicare might make $220,000 but one who only accepts private insurance could make $500,000-$700,000+ per year It’s all a scam. They only preach what makes them rich

WOW 🚨 Michigan Senate candidate Abdul El-Sayed is a Socialist but he’s RICH!! Tax filings show El-Sayed's household earned more than $686,000 in 2025, that’s nearly 10x Michigan's median household income Just like Bernie Sanders, he’s a rich hypocrite “One reason the Medicare for All candidate is raking in cash and backlash is that his wife, a psychiatrist, does not accept Medicare, or any other insurance plan at her practice” Wait just one second…. So his wife is denying cheaper taxpayers funded patients with negotiated government rates and instead only accepts the most profitable patients made possible through our capitalist Big Health Insurance industry??? For those who don’t understand the math here, she’s denying low income patients to make 2-3x+ more per patient with private insurance A psychiatrist that accepts Medicare might make $220,000 but one who only accepts private insurance could make $500,000-$700,000+ per year It’s all a scam. They only preach what makes them rich

Wall Street Apes

163,193 views • 2 months ago

🚨 JUST IN: A $1 BILLION DOLLAR Medicare fraudster has just been CONVICTED in Florida, and now faces up to 20 years in prison He and his co-conspirators used FOREIGN CALL CENTERS to target "hundreds of THOUSANDS of Medicare beneficiaries" KEEP CRUSHING THE FRAUD 🔥 This fraudster preyed on society's most vulnerable, with the DOJ saying he coerced the elderly into buying unnecessary medical equipment It ultimately cost taxpayers $1 billion. Of course, he owned a massive, waterfront property. "Investigators say he and his co-conspirators used foreign call centers to target hundreds of thousands of Medicare beneficiaries and bribe telemedicine doctors to write them bogus prescriptions for medical equipment they did not need." "Then they say the fraudsters would bill Medicare for it costing taxpayers more than a billion dollars with a B." "The assistant attorney general of the DOJ's National Fraud Enforcement Division said it will continue to aggressively prosecute health care fraud schemes, hold criminals accountable and protect the integrity of America's health care system." Kayleigh McEnany

🚨 JUST IN: A $1 BILLION DOLLAR Medicare fraudster has just been CONVICTED in Florida, and now faces up to 20 years in prison He and his co-conspirators used FOREIGN CALL CENTERS to target "hundreds of THOUSANDS of Medicare beneficiaries" KEEP CRUSHING THE FRAUD 🔥 This fraudster preyed on society's most vulnerable, with the DOJ saying he coerced the elderly into buying unnecessary medical equipment It ultimately cost taxpayers $1 billion. Of course, he owned a massive, waterfront property. "Investigators say he and his co-conspirators used foreign call centers to target hundreds of thousands of Medicare beneficiaries and bribe telemedicine doctors to write them bogus prescriptions for medical equipment they did not need." "Then they say the fraudsters would bill Medicare for it costing taxpayers more than a billion dollars with a B." "The assistant attorney general of the DOJ's National Fraud Enforcement Division said it will continue to aggressively prosecute health care fraud schemes, hold criminals accountable and protect the integrity of America's health care system." Kayleigh McEnany

Eric Daugherty

246,771 views • 4 months ago

CONSPIRACY THEORY NO MORE: Dr. Oz, Administrator of the Centers for Medicare & Medicaid Services, confirms: How the f**k is this any different from what the Somalians have done in Minnesota? A CRIMINAL CONSPIRACY—the single greatest robbery in U.S. history. “We have proven that over a billion dollars—paid by U.S. taxpayers—has gone to illegal aliens in about half a dozen states.” 📝 Your generosity has been deceived. Robbed. Betrayed. Extorted. Defrauded.

CONSPIRACY THEORY NO MORE: Dr. Oz, Administrator of the Centers for Medicare & Medicaid Services, confirms: How the f**k is this any different from what the Somalians have done in Minnesota? A CRIMINAL CONSPIRACY—the single greatest robbery in U.S. history. “We have proven that over a billion dollars—paid by U.S. taxpayers—has gone to illegal aliens in about half a dozen states.” 📝 Your generosity has been deceived. Robbed. Betrayed. Extorted. Defrauded.

🇺🇸RealRobert🇺🇸

69,462 views • 8 months ago

Today we’re announcing the CMS Innovation Center’ BALANCE Model that aims to increase access to select GLP-1 medications and support for healthy lifestyle choices for people with Medicare Part D and Medicaid, delivering better affordability and health. 7 out of 10 Americans struggle with weight, which often contributes to health problems like heart disease, diabetes, and stroke. This model will empower patients and help them take control of their long-term health. Learn more:

Today we’re announcing the CMS Innovation Center’ BALANCE Model that aims to increase access to select GLP-1 medications and support for healthy lifestyle choices for people with Medicare Part D and Medicaid, delivering better affordability and health. 7 out of 10 Americans struggle with weight, which often contributes to health problems like heart disease, diabetes, and stroke. This model will empower patients and help them take control of their long-term health. Learn more:

DrOzCMS

12,045 views • 9 months ago

Mark Cuban says the U.S. may need an entirely new healthcare system, but supporters of Medicare for All are promoting “bullshit” instead of presenting a workable plan. He spoke to Kara Swisher about the new Yale-led report which projects $1.04 trillion in annual savings by switching to M4A, taking exception with its estimated $285.7 billion reduction in fraudulent billing. That figure applies an 8% savings associated with Taiwan’s 1995 transition to single-payer healthcare to U.S. spending. Cuban argues that extrapolating from Taiwan’s much smaller, then largely paper-based system makes the estimate entirely unreliable. He also argues that leading hospitals and doctors would opt out if paid at Medicare rates, and that a politically appointed Health and Human Services secretary would wield broad authority over implementation of the plan. Source: Pivot podcast (linked below) Mark Cuban | Kara Swisher

Mark Cuban says the U.S. may need an entirely new healthcare system, but supporters of Medicare for All are promoting “bullshit” instead of presenting a workable plan. He spoke to Kara Swisher about the new Yale-led report which projects $1.04 trillion in annual savings by switching to M4A, taking exception with its estimated $285.7 billion reduction in fraudulent billing. That figure applies an 8% savings associated with Taiwan’s 1995 transition to single-payer healthcare to U.S. spending. Cuban argues that extrapolating from Taiwan’s much smaller, then largely paper-based system makes the estimate entirely unreliable. He also argues that leading hospitals and doctors would opt out if paid at Medicare rates, and that a politically appointed Health and Human Services secretary would wield broad authority over implementation of the plan. Source: Pivot podcast (linked below) Mark Cuban | Kara Swisher

Drop Site

192,715 views • 1 month ago

At the recently held District Roads Committee meeting, I raised concern over the inflated rates at which the Municipality has been procuring road works and related services. I pointed out that cheaper rates are available within the district, and we must ensure value for money in every procurement. Tororo Municipality has previously faced concerns around corruption, unaccounted funds and poor service delivery. We cannot allow such practices to continue. Procuring at the right and competitive prices means we can do more work with the same resources and ultimately deliver more for our people.

At the recently held District Roads Committee meeting, I raised concern over the inflated rates at which the Municipality has been procuring road works and related services. I pointed out that cheaper rates are available within the district, and we must ensure value for money in every procurement. Tororo Municipality has previously faced concerns around corruption, unaccounted funds and poor service delivery. We cannot allow such practices to continue. Procuring at the right and competitive prices means we can do more work with the same resources and ultimately deliver more for our people.

Shyam Tanna

33,487 views • 1 month ago

REPORT: Elon Musk says DOGE has uncovered $100 BILLION in Medicare and Medicaid waste after gaining access to the system. “This is where the big money fraud is happening.” DOGE’s team has been reviewing CMS payment and contracting systems. What they found is staggering: “They wasted $100B of taxpayer money!” Musk declared. The fraud allegations come as CMS admits to cracking down on bad actors. From June to October 2024, the agency suspended 850 brokers for fraudulently enrolling Americans into plans without consent. Meanwhile, the DOJ charged 193 defendants last summer for a $2.75 BILLION healthcare fraud scheme, including 76 medical professionals. But according to Musk, that’s just scratching the surface. The Health Care Fraud Unit has already uncovered over $27 billion in fraud since 2007, and DOGE’s deep dive suggests the real number may be far worse. Musk’s message couldn’t be clearer: Medicare and Medicaid are hemorrhaging taxpayer money at an unfathomable scale. The only positive is that at least we discovered this now before it completely bankrupts the country.

REPORT: Elon Musk says DOGE has uncovered $100 BILLION in Medicare and Medicaid waste after gaining access to the system. “This is where the big money fraud is happening.” DOGE’s team has been reviewing CMS payment and contracting systems. What they found is staggering: “They wasted $100B of taxpayer money!” Musk declared. The fraud allegations come as CMS admits to cracking down on bad actors. From June to October 2024, the agency suspended 850 brokers for fraudulently enrolling Americans into plans without consent. Meanwhile, the DOJ charged 193 defendants last summer for a $2.75 BILLION healthcare fraud scheme, including 76 medical professionals. But according to Musk, that’s just scratching the surface. The Health Care Fraud Unit has already uncovered over $27 billion in fraud since 2007, and DOGE’s deep dive suggests the real number may be far worse. Musk’s message couldn’t be clearer: Medicare and Medicaid are hemorrhaging taxpayer money at an unfathomable scale. The only positive is that at least we discovered this now before it completely bankrupts the country.

The Vigilant Fox 🦊

510,922 views • 1 year ago

UnitedHealth just earned a $3.9 billion bonus from taxpayers. For a job well done, supposedly. The 2026 Medicare Advantage quality bonus payouts are out, and the federal government is handing insurers at least $13.4 billion this year. That is roughly $700 million more than last year, and more than four times what the program paid in 2015. Since 2015, these bonuses have totaled over $87 billion. Now here is the part that should stop you. These are called quality bonus payments. They are supposed to reward plans for delivering better care. But the share of Medicare Advantage members enrolled in a plan that qualifies for the bonus actually fell this year, from 75% down to 68%, the lowest level since 2018. If this program truly tracked quality, a drop like that should shrink the bill. Instead the bill went up. That tells you the giants have not gotten better. They have gotten better at gaming the system. The way you unlock the bonus is by hitting 4 or more stars in the CMS Star Ratings program. Reach that threshold and your federal payments get bumped up. Sounds reasonable until you learn the ratings are scored at the contract level rather than the individual plan level, which makes the number something you can consolidate, manage, and engineer. Critics have been flagging this for years. The Congressional Budget Office estimated that simply ending the quality bonus program would save taxpayers nearly $100 billion over a decade. MedPAC has proposed replacing it outright. I do not work deep in the star rating world, but I have felt its edges at my own counter. A doctor once pushed a patient to leave my pharmacy and go back to a big chain, where she paid about $30 more every single month. Why would a doctor do that? Because independent pharmacies like mine do not always count toward a plan's star measures. Steering her elsewhere helped protect the bonus. She paid more so a giant could chase a check. Needless to say, I am not a fan. Look at who actually cashes these checks. UnitedHealth Group is set to collect $3.9 billion, about 29% of the entire pool, while covering roughly 26% of enrollees. Humana lands around $1.5 billion after its star scores slipped. And the biggest jump per person goes to Kaiser Permanente at an extra $577 per enrollee, because nearly all of its members sit in 4-star-plus plans. At Kaiser's scale, $577 a head adds up fast. So here is my honest question. This is a quality bonus. Reviews of the research keep finding little evidence that Medicare Advantage members actually receive meaningfully better care than people in traditional Medicare. Did any of you notice $13 billion worth of better care this year? Or did all these bonuses add up to nothing for the actual patient? And remember where the money comes from. Taxpayers fund it, and it flows through in premiums and drug costs. When you pay cash at a transparent pharmacy, there is no bonus machine buried in your receipt. You just pay for the medicine.

UnitedHealth just earned a $3.9 billion bonus from taxpayers. For a job well done, supposedly. The 2026 Medicare Advantage quality bonus payouts are out, and the federal government is handing insurers at least $13.4 billion this year. That is roughly $700 million more than last year, and more than four times what the program paid in 2015. Since 2015, these bonuses have totaled over $87 billion. Now here is the part that should stop you. These are called quality bonus payments. They are supposed to reward plans for delivering better care. But the share of Medicare Advantage members enrolled in a plan that qualifies for the bonus actually fell this year, from 75% down to 68%, the lowest level since 2018. If this program truly tracked quality, a drop like that should shrink the bill. Instead the bill went up. That tells you the giants have not gotten better. They have gotten better at gaming the system. The way you unlock the bonus is by hitting 4 or more stars in the CMS Star Ratings program. Reach that threshold and your federal payments get bumped up. Sounds reasonable until you learn the ratings are scored at the contract level rather than the individual plan level, which makes the number something you can consolidate, manage, and engineer. Critics have been flagging this for years. The Congressional Budget Office estimated that simply ending the quality bonus program would save taxpayers nearly $100 billion over a decade. MedPAC has proposed replacing it outright. I do not work deep in the star rating world, but I have felt its edges at my own counter. A doctor once pushed a patient to leave my pharmacy and go back to a big chain, where she paid about $30 more every single month. Why would a doctor do that? Because independent pharmacies like mine do not always count toward a plan's star measures. Steering her elsewhere helped protect the bonus. She paid more so a giant could chase a check. Needless to say, I am not a fan. Look at who actually cashes these checks. UnitedHealth Group is set to collect $3.9 billion, about 29% of the entire pool, while covering roughly 26% of enrollees. Humana lands around $1.5 billion after its star scores slipped. And the biggest jump per person goes to Kaiser Permanente at an extra $577 per enrollee, because nearly all of its members sit in 4-star-plus plans. At Kaiser's scale, $577 a head adds up fast. So here is my honest question. This is a quality bonus. Reviews of the research keep finding little evidence that Medicare Advantage members actually receive meaningfully better care than people in traditional Medicare. Did any of you notice $13 billion worth of better care this year? Or did all these bonuses add up to nothing for the actual patient? And remember where the money comes from. Taxpayers fund it, and it flows through in premiums and drug costs. When you pay cash at a transparent pharmacy, there is no bonus machine buried in your receipt. You just pay for the medicine.

Forest Park Pharmacy

12,226 views • 2 months ago

Some things you just can't make up. Instead of discussing how Medicaid and Medicare fraud harms our seniors and the most vulnerable, my Democrat colleagues would rather play semantics with the definition of the word fraud! It's common sense; fraud is when: 🔘$14 billion has been scammed from the system 🔘People's identities are stolen, and they can't receive the benefits they are owed 🔘Scammers, including foreign entities, set up fake Medicare and Medicaid accounts to receive illegitimate benefits 🔘Bad-faith health providers bill the taxpayer for services they never provided to patients Energy and Commerce Committee is taking action to root out waste, fraud, and abuse in government.

Some things you just can't make up. Instead of discussing how Medicaid and Medicare fraud harms our seniors and the most vulnerable, my Democrat colleagues would rather play semantics with the definition of the word fraud! It's common sense; fraud is when: 🔘$14 billion has been scammed from the system 🔘People's identities are stolen, and they can't receive the benefits they are owed 🔘Scammers, including foreign entities, set up fake Medicare and Medicaid accounts to receive illegitimate benefits 🔘Bad-faith health providers bill the taxpayer for services they never provided to patients Energy and Commerce Committee is taking action to root out waste, fraud, and abuse in government.

Rep. Brett Guthrie

30,184 views • 7 months ago

WOW 🚨 Dr Oz, Administrator for the Centers for Medicare & Medicaid Services, announces they have evidence 6 Democrat states have been stealing federal tax dollars for healthcare for illegals Over a billion dollars stolen in just the last few months “We decided to investigate it ourselves 'cause I don't really trust these six states. — We found already $1.3 billion has been inappropriately taken from federal taxpayers in just the past few months. We just clawed back $300 million, which signals that the six states, they already know. They acknowledge that this is an embarrassing reality”

WOW 🚨 Dr Oz, Administrator for the Centers for Medicare & Medicaid Services, announces they have evidence 6 Democrat states have been stealing federal tax dollars for healthcare for illegals Over a billion dollars stolen in just the last few months “We decided to investigate it ourselves 'cause I don't really trust these six states. — We found already $1.3 billion has been inappropriately taken from federal taxpayers in just the past few months. We just clawed back $300 million, which signals that the six states, they already know. They acknowledge that this is an embarrassing reality”

Wall Street Apes

793,729 views • 10 months ago