Medicare Advantage is broken. UnitedHealthcare's probe is just a symptom

Overbilling is rampant within the program.

UnitedHealthcare just confirmed it is under investigation by the Department of Justice for Medicare Advantage fraud. It’s not the first misstep for the healthcare conglomerate, but it’s also part of a larger disconnect between government healthcare and the private sector.

Over the past decade, the federal government has repeatedly criticized insurance giants such as UHC, CVS Health, Humana and Elevance Health for fraudulent overbilling in Medicare Advantage plans. Yet while these companies represent 60% of the Medicare Advantage market, Washington provided the incentives and the health systems for insurers to game.

This fraud doesn’t just drain taxpayer dollars; it erodes trust in our healthcare system. It needs to stop.

Medicare Advantage is often a lifeline for those not wanting to enter the complicated web that is government-run healthcare. These plans enable a private company to give patients a full-service healthcare package with certain benefits and coverage options. Instead of the government intervening in medical care, they just handle the check.

But that leaves gaps in accountability. To maximize profits, insurers will overbill for nearly every treatment in an Medicare Advantage plan while the government is none the wiser. This results in the average taxpayer having to foot the cost. If this were a relationship between an insurance company and a patient, the patient would recognize the fraud and potential overpayments would cease immediately. But the government is the one actor letting this fraud transpire.

https://www.tampabay.com/viewpoints/2025/08/18/medicare-advantage-is-broken-unitedhealthcares-probe-is-just-symptom-column/