Medicare Advantage? If You Say So. Fraud, Waste, And Abuse In Medicare Part C

Abstract

Debates about health care often emphasize distributive justice. How should society allocate finite resources? Who will get access to them, who will not? Is the allocation fair? Who decides and by what standard? Answers to these questions rarely consider health care fraud, waste, and abuse. This is a material omission. Fraud alone costs the health care system billions of dollars annually, dissipating limited funds and degrading quality of care. This paper considers how fraud, waste, and abuse occur in Medicare Part C – better known as Medicare Advantage – an increasingly popular coverage option. Medicare Advantage experiences unique challenges that undermine the program and squander the public’s investment in it. Only by accounting for these programmatic vulnerabilities can we then go on to assess whether Medicare Advantage is an effective, cost-efficient, and equitable mechanism for delivering health insurance coverage.