Jayapal Leads Amicus Brief Opposing UnitedHealth Efforts to Scam Taxpayers through Medicare Advantage

WASHINGTON — U.S. Representative Pramila Jayapal (WA-07) is leading dozens of Members in filing an amicus brief in United States of America v. UnitedHealth Group, Inc. et al, a case alleging that UnitedHealth uses inaccurate diagnosis codes to inflate payments through Medicare Advantage (MA), essentially embezzling from taxpayers. The Medicare Payment Advisory Commission (MedPAC) estimates that MA plans through insurers like UnitedHealth will be overpaid by $1.2 trillion between 2025-2034 without intervention. 

“Medicare DisAdvantage, as I like to call it, was initially created as a way to save taxpayer dollars, but in reality, it does the exact opposite. It costs more and consistently has worse patient outcomes,” said Jayapal. “Today, this program is simply a cash cow for big insurance corporations at the cost of seniors and people with disabilities. UnitedHealth must answer to a jury, to the allegations that its network of MA plans intentionally ‘upcoded’ to increase the payments it received from Medicare — taxpayer dollars that did not go to provide healthcare to patients, but rather to pad UnitedHealth’s profits. Americans deserve to know if Medicare funds have been—and could continue to be—abused.”

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 CMS by at least $83 billion in 2024 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. UnitedHealth is the nation’s largest insurer of MA plans, with 28 percent of the market share nationally and $400 billion in revenue last year. 

“The MA Program was supposed to decrease costs and increase access to healthcare for elderly and disabled Americans, while simultaneously adding efficiency to the healthcare system. Corporate health insurers like United have guaranteed MA’s failure by wringing the program dry with their insatiable appetite for profit,” reads the brief.

When a patient receives treatment through a third-party MA insurer, like UnitedHealth, they are assigned a “sickness score” that determines the payments to the insurer from the Traditional Medicare fund. Those sickness scores are driven by the post hoc diagnoses of United’s coders, and this case states that UnitedHealth knew that $2.1 billion in payments were due to incorrect diagnoses, yet did nothing to correct the error and instead took the money at a time when Americans are paying nearly $26,000 per family in premiums per year, while the largest US insurer made $14 billion in annual profits. And just this week, the Wall Street Journal reported that UnitedHealth is under investigation by the Department of Justice for possible criminal Medicare fraud.

Jayapal has been a leader in the efforts to rein in MA and protect patients, having led efforts to urge both the Trump and Biden Administrations to enact reforms. 

The brief was signed by Yassamin Ansari (AZ-03), Becca Balint (VT-AL), Greg Casar (TX-35), Steve Cohen (TN-09), Valerie Foushee (NC-04), Sylvia Garcia (TX-29), Jesús G. “Chuy” García (IL-04), Maggie Goodlander (NH-02), Val Hoyle (OR-04), Glenn Ivey (MD-04), Henry C. “Hank” Johnson, Jr. (GA-04), Sydney Kamlager-Dove (CA-37), Ro Khanna (CA-17), Greg Landsman (OH-01), James P. McGovern (MA-02), LaMonica McIver (NJ-10), Eleanor Holmes Norton (DC-AL), Ilhan Omar (MN-05), Chellie Pingree (ME-01), Delia Ramirez (IL-03), Pat Ryan (NY-18), Jan Schakowsky (IL-09), Mark Takano (CA-39), Rashida Tlaib (MI-12), Jill Tokuda (HI-02), Derek Tran (CA-45), Nydia M. Velázquez (NY-07), Bonnie Watson Coleman (NJ-12), and Nikema Williams (GA-05).

The full text of the brief can be read here. 

Issues: Health Care