April 01, 2025

Ahead of Dr. Oz’s Confirmation, Senators Urge Crackdown on Private Medicare Insurers that Scam Patients, Price Gouge Taxpayers

Senators call for ending contracts, limiting enrollment for Medicare Advantage insurers that defraud seniors and taxpayers

“The most effective step the Administration can take in cutting waste, fraud, and abuse in federal health care programs is by reining in the wasteful practices of corporate health insurers in the MA program.” 

Text of Letter (PDF)

Washington, D.C. – U.S. Senator Elizabeth Warren (D-Mass.) led a group of Senate Democrats in writing to Robert F. Kennedy Jr., Secretary of Health and Human Services, and Stephanie Carlton, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), urging them to crackdown on abuses by private insurers in Medicare Advantage (MA) that overcharge taxpayers, raise costs for patients, and create barriers to access care. 

Senators Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Richard Durbin (D-Ill.), Edward J. Markey (D-Mass.), Jeff Merkley (D-Ore.), Bernie Sanders (I-Vt.), and Tina Smith (D-Minn.) joined in signing the letter. 

While the MA program was founded on the premise that private insurers could administer Medicare more cost-efficiently than the federal government, the program has failed to deliver savings in any year since its inception. In fact, in 2024 alone, private insurers in the program overcharged taxpayers by $83 billion relative to Traditional Medicare, while overpayments to private insurers in MA are expected to total $1.2 trillion dollars over the next decade.

Despite these massive taxpayer overpayments, private insurers in MA routinely slow down and deny medically necessary care for patients that otherwise would be approved under Traditional Medicare. MA patients are also more likely to be given inadequate care due to profit-padding insurance tactics, including early hospital discharges and shorter lengths of stay in care settings like nursing homes. 

“At a time when Americans are paying nearly $26,000 per family in premiums per year, while the largest US insurer made $23 billion in annual profits, reining in profiteering could not be more important,” wrote the senators. 

Ahead of CMS finalizing the 2026 Medicare Advantage Rate Notice (2026 Rate Notice), which sets payment rates for insurers in the program, the senators asked CMS to make four key reforms to the Medicare Advantage rules:  

  1. Eliminate waste and abuse from overpayments: CMS should finalize and adopt new rules for how risk adjustment is calculated, which will limit insurers’ misuse of diagnosis codes and save taxpayers $3.4 billion. Additionally, CMS should take the necessary enforcement actions, including restricting future enrollment in plans that engage in fraud and terminating MA plan contracts, to ensure MA organizations report and return overpayments in a timely manner.
  2. Strengthen enforcement against MA insurers that illegally deny care: CMS should conduct strong oversight and enforcement when reviewing and approving MA benefits to ensure they adequately cover patients and do not subject enrollees to inappropriate and unnecessary barriers to care, like incorrect prior authorization determinations. About 50 million prior authorization requests were required by MA insurers in 2023, most commonly for higher cost, urgent services such as chemotherapy, inpatient hospital stays, and skilled nursing facility stays. 
  3. Address additional barriers to care: CMS should develop new regulations to crack down on MA insurer’s use of artificial intelligence programs, which have been used to incorrectly deny life-saving care and dangerously discharge patients early. The senators also pressed CMS to hold MA insurers accountable for using “ghost” networks to restrict care for seniors and people with disabilities. 
  4. Enact reforms to reduce disparities in care: The lawmakers urged lawmakers to take steps to improve disparities in care across race, ethnicity, and ability.

“These actions are crucial to improve health outcomes and ensure Medicare’s sustainability for future generations,” concluded the senators.

Senator Warren is a leading voice on reining in abuses in Medicare Advantage and protecting patients:

  • In March 2025, at a hearing of the Senate Finance Committee, Senator Elizabeth Warren pressed Dr. Oz on taxpayer fraud committed by private, for-profit insurers in the Medicare Advantage program. Dr. Oz agreed with Senator Warren that cracking down on private health insurers in Medicare Advantage will “improve the health care of the American people.”
  • In March 2025, Senator Elizabeth Warren wrote to Dr. Mehmet Oz, Trump’s nominee for Administrator of the Centers for Medicare & Medicaid Services (CMS), pressing him on his serious conflicts of interest. Dr. Oz has long been tied to Medicare Advantage insurers, which would benefit if he successfully privatizes Medicare, and which have paid him to encourage his show’s viewers to enroll in private Medicare plans. 
  • In January 2025, in a Fox News Digital op-ed, Senator Elizabeth Warren outlined her recommendations for cutting government waste to make government more efficient and save taxpayers money, including by rooting out corruption by Medicare Advantage insurers. 
  • In January 2025, Senator Elizabeth Warren sent Elon Musk, Chair of the Department of Government Efficiency (DOGE), a letter detailing over 30 proposals that would cut at least $2 trillion of wasteful government spending over the next decade, including by curbing abuse by Medicare Advantage insurers that overcharge taxpayers.
  • In December, 2024, Senator Elizabeth Warren and Representative Lloyd Doggett (D-Texas) urged the Center for Medicare and Medicaid Services (CMS) to finalize rules to curb overpayments to private insurers in Medicare Advantage.
  • In December 2024, Senators Elizabeth Warren led a group of Congressional Democrats in a letter to Dr. Mehmet Oz, President-elect Donald Trump’s pick to lead the Centers for Medicare & Medicaid Services, raising stark concerns about his advocacy to eliminate Traditional Medicare and his deep financial ties to the private health insurers that would benefit from that move.
  • In June 2024, Senator Elizabeth Warren wrote to the Department of Justice, the Department of Health and Human Services, and the Federal Trade Commission, calling out high health care costs due to vertically-integrated insurers, private equity companies, and pharmaceutical companies that are driving health care consolidation. The letter came in response to the three agencies’ March 2024 cross-government inquiry into the impacts of corporate greed in health care, and highlights examples of abusive and anticompetitive behavior by companies in the health care industry.
  • In May 2024, at a hearing of the U.S. Senate Committee on Finance, Senator Warren called out private insurers in Medicare Advantage for accelerating the rural hospital crisis.
  • In March 2024, Senators Warren and Brown led their colleagues in a letter to HHS and CMS that urged the agencies to protect seniors by holding insurance companies accountable for abuses in Medicare Advantage.
  • In January 2024, Senator Warren and Representative Pramila Jayapal (D-Wash.) sent a letter to CMS, urging the agency to take administrative action to curb billions in overpayments to MA insurers.
  • In December 2023, Senators Warren, Catherine Cortez Masto (D-Nev.), Bill Cassidy (R-La.), and Marsha Blackburn (R-Tenn.) sent a letter to the CMS Administrator Chiquita Brooks-LaSure, raising concerns about shortfalls in CMS’s data collection and reporting practices for MA plans, and urging CMS to close data gaps to strengthen oversight of MA plans and improve care for Medicare beneficiaries. 
  • In November 2023, Senators Warren, Cortez Masto, Cassidy, and Blackburn introduced bipartisan legislation to improve transparency of MA plans and ensure these plans are best serving the health care needs of America’s seniors. The Encounter Data Enhancement Act would require Medicare Advantage plans to report important information about how much they are actually paying for patient services and how much patients are responsible for paying out-of-pocket. 
  • In November 2023, at a Senate Finance Committee markup of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, Senator Warren highlighted the need to do more to prioritize hearing health for seniors and strengthen transparency in Medicare Advantage, and secured commitments from Senate Finance Committee leadership to prioritize these proposals in future packages. 
  • In October 2023, at a hearing of the Senate Finance Committee, Senator Warren called out giant MA insurers for using deceptive marketing tactics to lure seniors into the wrong plans and drown out competition from smaller insurers that may offer better coverage. Senator Warren called on CMS to act within the fullest extent of its authority to crack down on MA insurers that game the system to overcharge the government and to ensure insurers publish accurate data on patient care and out-of-pocket costs. 
  • In May 2023, at a hearing of the Senate Finance Committee, Senator Warren highlighted the prevalence of ghost networks in Medicare Advantage plans and called for stronger oversight of the program.
  • In March 2023, Senator Warren sounded the alarm on a new analysis by policy experts showing that all Medicare beneficiaries – including those enrolled in Traditional Medicare – are paying higher premiums due to overpayments in MA. She sent a letter to CMS and called on the agency to finalize its proposed rule to ensure payments to MA plans accurately reflect the cost of care. 
  • In March 2023, U.S. Senators Warren and Jeff Merkley (D-Ore.) sent letters to the top seven MA insurers – Humana, Centene, UnitedHealthcare, CVS/Aetna, Molina, Elevance Health, and Cigna – regarding their questionable claims that CMS’s 2024 proposed Medicare Advantage payment rules would hurt beneficiaries.
  • In March 2023, at a hearing of the Senate Finance Committee, Senator Warren defended CMS’s proposed adjustments to the Calendar Year 2024 MA payment rates, pushing back against giant insurance companies and their lobbyists who are peddling misinformation to protect their billions in profits and scare beneficiaries into opposing the rule. 
  • In April 2022, Senator Warren and Representatives Katie Porter (D-Calif.), Rosa DeLauro (D-Conn.), and Jan Schakowsky (D-Ill.) led their colleagues in sending a letter to CMS Administrator Chiquita Brooks-LaSure highlighting concerns about overpayments to Medicare Advantage plans that line the pockets of big insurance companies.
  • In February 2022, chairing a hearing of the Senate Finance Subcommittee on Fiscal Responsibility and Economic Growth, Senator Warren delivered remarks about strengthening Medicare and cracking down on pharmaceutical and insurance companies’ corporate greed to pay for expanded coverage.

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