Speaking before the Joint Energy Committee, Brown University public health researcher David Meyers offered policy options to improve Medicare Advantage integrity, reduce waste for taxpayers.
WASHINGTON, D.C. [Brown University] - Medicare Advantage overpayments are an example of a vulnerability in the healthcare system that results in higher costs to taxpayers, according to Brown University health services researcher David Meyers, but Congress can effectively address waste in the healthcare system by reforming Medicare Advantage.
"A payment system that systematically overpays by this magnitude is neither fiscally sustainable nor fair to the beneficiaries and taxpayers who fund it," said Meyers, an associate director of the Center for Advancing Health Policy through Research at Brown's School of Public Health.
In testimony offered before Congress on Wednesday, June 24, Meyers suggested strategic reforms to Medicare Advantage that would cut waste, improve efficiency and save money.
He was among of a panel of experts who testified in a hearing, titled "Protecting Patients and Taxpayers: Combating Healthcare Fraud and Leakage to Strengthen Program Integrity," organized by the Joint Economic Committee. An associate professor of health services, policy and practice at Brown, Meyers was invited to testify given his research on Medicare Advantage payment and program integrity.
Meyers has spent the past several years alongside colleagues at Brown building the empirical record on where Medicare Advantage payments diverge from what beneficiary care costs and on larger inefficiencies in the program. His remarks to Congress were informed by his team's research on risk score coding (or correlating patient diagnoses and health risks with insurance plan codes), plan payment and consolidation in the Medicare Advantage program.
Medicare Advantage is a Medicare-approved plan from a private company, and while it was originally designed to save money relative to traditional Medicare, Meyers said that it never has.
"Our work estimates that in 2026 alone, the federal government will pay Medicare Advantage plans roughly $100 billion more than those same beneficiaries would have cost under Medicare," Meyers said during his testimony. "This includes estimates of differential coding intensity, favorable selection and other inefficiencies which I discuss in my written testimony."
In his remarks, Meyers highlighted three sources of overpayment: documenting diagnoses more intensively than traditional Medicare, even for beneficiaries with the same underlying health, in order to receive higher reimbursements; duplicative spending on veterans enrolled in both Medicare Advantage and the Veteran's Affairs health care; and bonus payments for higher rated plans that don't actually translate into better outcomes for beneficiaries.
"While some of this is fraud, all of it is largely wasteful," he said. "These payment differences constitute a form of leakage from the healthcare system where the insurers that operate Medicare Advantage plans are able to extract substantial funding from the federal government with unclear value for beneficiaries."
The good news, Meyers said, is that there are well-defined, evidence-based options for each of these challenges, and in most cases, Congress has already introduced relevant legislation.
In his remarks and during the subsequent Q&A session, Meyers reiterated that cutting waste and saving money doesn't require dismantling Medicare Advantage.
"Many beneficiaries value the program and what it provides," he said. "The reforms I've outlined would keep Medicare Advantage strong while narrowing the gap between what plans are paid and what care actually costs. Most of them, however, will require Congress to act."
