The latest in for-profit health care scandals

To the editor:

For those of you who do not read the Wall Street Journal, the article “The One-Hour Nurse Visits That Let Insurers Collect $15 Billion from Medicare” published Aug. 4, 2024, would be interesting reading.

Carefully researched by the Journal’s investigative reporters and well written, the article documents how insurers use nurses’ home visits to add lucrative diagnoses to each patient’s record. The publication reports, “In the Medicare Advantage system — conceived as a lower-cost alternative to traditional Medicare — private insurers get paid a lump sum to provide health benefits to about half of the 67 million seniors and disabled people in the federal program. The payments go up when people have certain diseases, giving insurers an incentive to diagnose those conditions.”

In July, another Journal piece reported “insurers received nearly $50 billion in Medicare payments from 2019 to 2021 due to diagnoses they added themselves for conditions that no doctor or hospital treated. Many of the insurer-driven diagnoses were outright wrong or highly questionable.”

The profit incentive is so lucrative that any profit-based system will result in ever higher costs for patients and taxpayers. A single-payer solution, where the government administers payments, but leaves diagnoses and treatments to doctors, is needed to get health-care costs under control.

Helen Krim