Members Demand End to Fraud, Waste, and Abuse by Corporate Medicare Advantage Plans

Contact: Alexis.Torres@mail.house.gov

Washington, D.C. – Today, U.S. Representative Lloyd Doggett (D-Austin), Ranking Member of the Ways & Means Health Subcommittee, joined by Representatives Pramila Jayapal (WA-07), Rosa DeLauro (CT-03), and Jan Schakowsky (IL-09), led 74 lawmakers in calling on the Centers for Medicare and Medicaid Services (CMS) to rein in wasteful taxpayer overpayments to Medicare Advantage (MA) plans and enact other reforms to protect consumers’ access to health care. Unlike Traditional Medicare, MA plans are administered by private insurers and have been found to be fraught with waste and abuse while sacrificing patient outcomes for higher corporate profit and threatening the overall solvency of Medicare. 

“Initially promoted as a way to save taxpayer dollars and improve quality of care, the Medicare Advantage program has continuously cost more than if the same enrollees were covered by Traditional Medicare and has not improved health outcomes. We strongly urge you to rein in the wasteful and harmful practices committed by corporate health insurers in MA,” wrote the Members.

The private insurance companies running MA plans mislead the public by claiming their plans save money and improve care. However, private insurers in MA overcharged taxpayers by at least $83 billion in 2024 alone without any improvements to the quality of care for patients. These overpayments to private insurers threaten the stability of the entire Medicare program for the 65 million Americans who rely on it. 

“At a time when Americans are paying nearly $26,000 per family in premiums per year, while the largest US insurer made $23 billion in annual profits, reining in profiteering could not be more important,” continued the Members. 

The Members are specifically calling on CMS and the Department of Health and Human Services to take the following actions: 

• Eliminate waste and abuse from overpayments by improving risk adjustment calculations in the proposed 2026 Medicare Advantage Rate Notice;
• Strictly enforce the overpayment regulations for Medicare Advantage Organizations outlined in the 2025 Medicare Physician Fee Schedule rule;
• Strengthen enforcement against MA insurers that illegally deny care;
• Address additional barriers to care, including by enforcing statutory requirements compelling insurers to disclose the methodology behind algorithms used for coverage decisions, and;
• Enact reforms to reduce disparities in care.

“We cannot continue to allow Medicare Advantage to be a source of profit for greedy companies and suffering for seniors and people with disabilities. Medicare Advantage has never delivered on the promise of actually lowering the cost or improving the quality of care,” said Eagan Kemp, Health Care Policy Advocate for Public Citizen. “In the short term, there must be enhanced oversight of the Medicare Advantage program to ensure enrollees get the care they need and bring down unnecessary overpayments. In the long run, we must improve and expand traditional Medicare to guarantee it is around for decades to come.”

The letter is cosigned by Alma Adams (NC-12), Yassamin Ansari (AZ-03), Becca Balint (VT-AL), Wesley Bell (MO-01), Donald Beyer (VA-08), Salud Carbajal (CA-24), André Carson (IN-07), Greg Casar (TX-35), Kathy Castor (FL-14), Joaquin Castro (TX-20), Sheila Cherfilus-McCormick (FL-20), Judy Chu (CA-28), Gilbert Cisneros (CA-31), Yvette Clarke (NY-09), Emanuel Cleaver (MO-05), Steve Cohen (TN-09), Danny Davis (IL-07), Christopher Deluzio (PA-17), Mark DeSaulnier (CA-10), Debbie Dingell (MI-06), Maxwell Frost (FL-10), John Garamendi (CA-08), Jesús García (IL-04), Robert Garcia (CA-42), Sylvia Garcia (TX-29), Daniel Goldman (NY-10), Al Green (TX-09), Val Hoyle (OR-04), Jared Huffman (CA-02), Glenn Ivey (MD-04), Jonathan Jackson (IL-01), Henry Johnson (GA-04), Robin Kelly (IL-02), Ro Khanna (CA-17), Raja Krishnamoorthi (IL-08), Greg Landsman (OH-01), George Latimer (NY-16), Summer Lee (PA-12), Teresa Leger Fernandez (NM-03), Zoe Lofgren (CA-18), Betty McCollum (MN-04), James McGovern (MA-02), LaMonica McIver (NJ-10), Grace Meng (NY-06), Kweisi Mfume (MD-07), Jerrold Nadler (NY-12), Eleanor Holmes Norton (DC), Alexandria Ocasio-Cortez (NY-14), Ilhan Omar (MN-05), Chellie Pingree (ME-01), Mark Pocan (WI-02), Ayanna Pressley (MA-07), Mike Quigley (IL-05), Delia Ramirez (IL-03), Emily Randall (WA-06), Luz Rivas (CA-29), Patrick Ryan (NY-18), Mary Gay Scanlon (PA-05), Robert Scott (VA-03), Brad Sherman (CA-32), Lateefah Simon (CA-12), Adam Smith (WA-09), Mark Takano (CA-39), Shri Thanedar (MI-13), Bennie Thompson (MS-02), Mike Thompson (CA-04), Rashida Tlaib (MI-12), Jill Tokuda (HI-02), Paul Tonko (NY-20), Lauren Underwood (IL-04), Nydia Velázquez (NY-07), Maxine Waters (CA-43), Bonnie Watson Coleman (NJ-12), and Nikema Williams (GA-05). 

This letter is endorsed by: Families USA, Center for Medicare Advocacy, Public Citizen, National Nurses United, MoveOn, Be a Hero, United Electrical, Radio & Machine Workers of America (UE), International Federation of Professional and Technical Engineers (IFPTE), Center for Health and Democracy, Center for Health Progress, Healthcare NOW, Progressive Democrats of America, Physicians for a National Health Program, Just Care USA, Social Security Works, Consumers Council of Missouri, People's Action, The People's Lobby, Progressive Maryland, National Health Care for the Homeless Council, Citizen Action of Wisconsin, Connecticut Citizen Action Group (CCAG), Physicians for a National Health Program of Minnesota, PSARA (Puget Sound Advocates for Retirement Action), Michigan United, and Citizen Action of New York. 

The full text of the letter can be read here.