America | Healthcare Crisis A


t $4.5 trillion a year, U.S. healthcare costs are spiraling out of


control, yet Americans are getting sicker every year. Newsmax Magazine, in its December issue, exposed how cancer rates are soaring, particularly among the young, three out of four people are overweight or obese, and our life expectancy is four years less than comparable Western nations. Soaring costs are driven


by greedy drug companies, a chaotic health insurance system, and corrupt regulators in Washington. Meanwhile, food manufacturers are filling supermarket shelves with addictive, ultra-processed foods made with chemicals and dyes that are banned in other countries. In January, we spotlighted


how insurers are making billions from Medicare Advantage plans using questionable diagnoses. This month we reveal


another example that is pushing up costs — how one Medicare insurance company used a checklist of diagnoses to generate bigger payments from the government.


22 NEWSMAX | FEBRUARY 2025


How Insurer Collected Billions From Medicare


It gave doctors checklist of potential diagnoses that would generate bigger payments.


BY CHRISTOPHER WEAVER, ANNA WILDE MATHEWS, AND TOM MCGINTY L


ike most doctors, nicho- las Jones prefers to diagnose patients after examining them.


When he worked for United-


Health Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them. UnitedHealth only did that with


the Eugene, Oregon, family physi- cian’s Medicare Advantage recipi- ents, he said, and its software wouldn’t let him move on to his next patient until he weighed in on each diagnosis. The diagnoses were often irrel-


evant or wrong, Jones said. United- Health sometimes suggested a hor- monal condition, secondary hyper- aldosteronism, that was so obscure


Jones had to turn to Google for help. “I needed to look it up,” he said. The government’s Medicare Advantage system, which uses pri- vate insurers to provide health ben- efits to seniors and disabled people, pays the companies based on how sick patients are, to cover the higher costs of sicker patients. Medicare calculates sickness


scores from information supplied by doctors and submitted by the insur- ers. In the case of UnitedHealth, many of those doctors work directly for UnitedHealth. More diagnoses make for higher


scores — and larger payments. A Wall Street Journal analysis


found sickness scores increased when patients moved from tradition- al Medicare to Medicare Advantage,


FEODORA CHIOSEA©ISTOCK


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100