Single Payer Healthcare - Effect on Medical Industry

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Excerpt from a New Yorker article on fraud in Medicare Adavantage.

The False Claims Act was strengthened in 1986, after a push by Senator Charles Grassley, of Iowa. Whistle-blowers can now share between fifteen and twenty-five per cent of the recovery, depending on such factors as the importance of their contribution. This change was an effort to recognize the financial toll of being a whistle-blower, both in lost employment and in legal fees incurred during the arduous process of building a case. The law effectively turned average citizens into a fleet of amateur federal agents, and it helped to reveal the staggering amount of money wrongfully extracted from government programs. A recent government report indicated that in 2017 alone almost $2.6 billion was recovered in health-care-fraud judgments and settlements. Two hundred and sixty-two million dollars of that was awarded to whistle-blowers.

Medicare Advantage, the program that Sewell believed Freedom was abusing, is at the center of a growing number of fraud cases, some of which involve the biggest names in the health-insurance industry. The regulations around the issue are complicated, however, and legal questions about what constitutes prosecutable fraud are still the subject of debate. In 2017, the Department of Justice joined a multimillion-dollar case against the nation’s largest insurer, UnitedHealth Group, alleging widespread fraud dating back to 2006. The Justice Department is also investigating several other health insurers, including Anthem, Humana, Cigna, Health Net, and Aetna. An analysis co-authored by Fred Schulte, at the Center for Public Integrity, estimated that insurance companies had received nearly seventy billion dollars in undeserved Medicare Advantage payments between 2008 and 2013.

https://www.newyorker.com/magazine/2019/02/04/the-personal-toll-of-whistle-blowing