Congress should cut Medicare Advantage profiteering. As Senate Republicans are working on passing their own version of the “One Big Beautiful Bill Act” that cuts federal spending on health care and lowers taxes, several senators have suggested cutting overpayments to insurance companies in the Medicare Advantage program. Reporting and commentary that portray this policy as “Medicare cuts” are overly simplistic, misleading, and ultimately aid large insurers that are stealing taxpayer dollars through exploiting the Medicare Advantage payment model.

Senator Bill Cassidy (R-LA) wants to include his No UPCODE Act with Senator Jeff Merkley (D-OR) in the One Big Beautiful Bill Act. Upcoding refers to one of the various practices that insurance companies, such as United Healthcare, have used to steal taxpayer dollars. 

In Traditional Medicare, the Centers for Medicare & Medicaid Services (CMS) reimburses providers for each service they provide to Medicare patients (this is called “fee-for-service”). In contrast, the Medicare Advantage Program has CMS pay private insurance companies to “manage” and cover enrolled patients. CMS gives companies a lump sum, or capitated payment, per enrollee based on factors like how healthy the patient is and thus how much money it would take to reasonably cover them. In theory, this model saves taxpayer money, as insurers have the incentive to save as much money as possible and steer patients towards preventative care.

Upcoding is the practice where insurance companies use false and/or irrelevant diagnoses to inflate covered patients’ risks scores (i.e. make them appear sicker) so that they can get higher capitated payments from taxpayers through CMS. 

We know that through practices like upcoding, health insurance companies have been stealing taxpayer dollars under the pretense of providing coverage for patients. The Medicare Payment Advisory Commission (MedPAC) has found that Medicare Advantage has never saved money compared to Traditional Medicare. For 2025, MedPAC estimates that taxpayers will overpay insurance companies to the tune of $84 billion. Based on this MedPAC estimate, the Committee for a Responsible Federal Budget  reports that overpayments – otherwise known as waste, fraud, and abuse – will be $1.2 trillion from 2025-2034.

Yet numerous media outlets have covered Republicans’ potentially limiting health insurance companies’ ability to steal taxpayer dollars in the privatized Medicare Advantage program as “Medicare cuts.” Politico has reported opposition from some congressional Democrats to targeting Medicare Advantage overpayments. Additionally, reporting has referenced the statement of the president and CEO of Better Medicare Alliance Mary Beth Donahue, who claimed that targeting overpayments would harm seniors by “break[ing] a promise to millions of seniors” supposedly through cutting their benefits. The Better Medicare Alliance is a lobbying organization that represents health insurance companies in the Medicare Advantage program. Stopping Medicare Advantage companies from lying and manipulating their way to get higher profits – working off the backs of taxpayers while never saving money compared to Traditional Medicare – is neither a cut to actual Medicare nor a cut to benefits.

The No UPCODE Act would inhibit insurance companies’ ability to inflate enrollee risk scores, and it is not the only Republican effort to cut back on Medicare Advantage waste. CMS Administrator Mehmet Oz has called companies that upcode “scoundrels.” On May 21, CMS announced an expansion to audits of Medicare Advantage plans to root out waste, fraud, and abuse.

The Center for Economic and Policy Research (CEPR) has been extremely critical of several of the congressional Republicans and the Trump Administration’s efforts to supposedly go after waste, fraud, and abuse that actually compromise vital public programs – whether it be changes to Medicaid, Social Security, the National Institutes of Health, and more.

Yet, the current proposal to cut Medicare Advantage overpayments actually eliminates enormous waste, fraud, and abuse where health insurers have stolen hundreds of billions of dollars from hardworking American taxpayers. 

The House version of the One Big Beautiful Bill Act did not include this reform, and it is not guaranteed to go in the final bill. And there of course are many critics of Medicare Advantage who do not support the overall Republican bill. But instead of blindly criticizing the Trump administration, everyone should support Senator Cassidy and any other policymaker – Republican or Democrat – in exposing and stopping this real heist that is robbing Americans.