{"id":79,"date":"2026-06-17T16:14:27","date_gmt":"2026-06-17T16:14:27","guid":{"rendered":"https:\/\/rachelfortn.com\/blog\/?p=79"},"modified":"2026-06-17T16:14:27","modified_gmt":"2026-06-17T16:14:27","slug":"when-they-yell-about-medicare-fraud-count-the-money","status":"publish","type":"post","link":"https:\/\/rachelfortn.com\/blog\/when-they-yell-about-medicare-fraud-count-the-money\/","title":{"rendered":"When they yell about “Medicare fraud,” count the money"},"content":{"rendered":"

Wanna hear one of Republican’s biggest scams to fool their voters?<\/p>\n

The first time you heard “Medicare fraud,” somebody on a stage was probably mad about it. Fists going. Taxpayers getting robbed. Bad guys gaming the system.<\/p>\n

And sure – some of that is real. People do steal from Medicare. There are crooks who bill for wheelchairs nobody got and surgeries nobody had. The “free back brace” robocall that won’t leave your phone alone is an actual scam, and people go to prison for it.<\/p>\n

But here’s the thing about that word. It’s doing a lot of jobs at once, and most of them aren’t what you think.<\/p>\n

Start with the giant numbers.<\/p>\n

When a politician says Medicare loses fifty or sixty billion dollars a year to fraud, they’re almost never counting fraud.<\/p>\n

They’re counting something called “improper payments.”<\/p>\n

A 2025 government analysis put those at 28.8 billion dollars in traditional Medicare and 23.7 billion in Medicare Advantage.<\/p>\n

Sounds damning. Except “improper” mostly means a paperwork problem – a missing signature, a wrong billing code, a payment that couldn’t be fully checked. CMS, the agency that runs Medicare, says it plainly: improper does not mean fraud.<\/p>\n

So when you hear “fraud” attached to that pile of money, somebody swapped the label.<\/p>\n

Now follow where the real money goes, because this is the part that doesn’t make the speeches.<\/p>\n

The biggest pot of wasted Medicare dollars isn’t street-level crooks. It’s the private insurance companies inside Medicare Advantage – the plans with the commercials, the gym memberships, the smiling actors.<\/p>\n

The way it works: the government pays those plans more for sicker patients. So the plans have a reason to make patients look as sick as possible on paper, whether they are or not. They code you up, they collect more.<\/p>\n

How much more? The people whose whole job is watching this – a federal panel called MedPAC – estimate the overpayments could hit 76 billion dollars in 2026, and 1.3 trillion over the next ten years.<\/p>\n

So, the “improper payment” panic is in the tens of billions. The Medicare Advantage overpayments are more than a trillion over a decade. One of these is the real money.<\/p>\n

Guess which one rarely gets the ranting.<\/p>\n

I’ll be fair here, because the fix isn’t to pretend none of it matters. There’s a legitimate case for going after waste – every dollar that leaks out is a dollar not spent on somebody’s actual care, and the people running these programs should be hard-nosed about it.<\/p>\n

But they need to be hard-nosed about the trillion-dollar leak, too.<\/p>\n

Have you ever heard a Republican say out loud: the insurance companies are ripping off the government?<\/p>\n

Cause I haven’t.<\/p>\n

They scream about fraud in a way that leads you to believe that immigrants and poor people are committing fraud to get free healthcare.<\/p>\n

And one more sleight of hand to watch for.<\/p>\n

A lot of what gets called “Medicare fraud” on a stump isn’t Medicare at all.<\/p>\n

It’s Medicaid, or it’s Obamacare – duplicate enrollees, coverage for immigrants, fake applications. House Republicans have pointed to 2.8 million duplicate Medicaid and ACA sign-ups and an estimated 27 billion dollars a year in improper Obamacare enrollments.<\/p>\n

Those are real arguments worth having. But you, the person hearing “Medicare,” picture your own benefits getting stolen. The actual target is the program that covers low-income kids and nursing-home grandparents. Different program, different people, same scary word.<\/p>\n

Why does the mix-up keep happening on purpose?<\/p>\n

Because “fraud, waste, and abuse” is the polite way to say “cut.” It’s the language you reach for when you want to trim who gets covered and not have it sound like that. The 2025 reconciliation law used exactly this framing – new work requirements and more frequent eligibility checks – to push people off the rolls.<\/p>\n

So next time the word comes flying at you, ask one question: are they going after the criminals, or going after the coverage?<\/p>\n

Those are not the same thing, and the people blurring them are counting on you not to notice.<\/p>\n

If you vote for me – I promise to drag the Medicare Advantage upcoding into the daylight instead of stepping around it. And a member can stop letting four words do the work of a cut nobody campaigned on.<\/p>\n

Out here in District 5 – across seventeen counties where a lot of folks are one bad diagnosis from real trouble – that’s the difference between a program that works and a talking point that doesn’t.<\/p>\n

\n

Sources<\/h3>\n
    \n
  1. Improper payment figures, traditional Medicare vs. Medicare Advantage (2025)<\/a><\/li>\n
  2. MedPAC Medicare Advantage overpayment estimates<\/a><\/li>\n
  3. House Energy & Commerce Republicans, Medicaid\/ACA enrollment figures<\/a><\/li>\n
  4. CMS, fraud vs. improper payment program integrity reporting<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Republicans rant about Medicare fraud. But the real money isn’t street-level crooks – it’s private Medicare Advantage plans overbilling taxpayers by more than a trillion over a decade. Here’s the trick, and who’s cashing in.<\/p>\n","protected":false},"author":1,"featured_media":78,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,5],"tags":[86,63,84,85,19,18,62,65,64,12],"class_list":["post-79","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-district-5","category-federal-policy","tag-healthcare","tag-medicaid","tag-medicare","tag-medicare-advantage","tag-memphis","tag-money-in-politics","tag-rural-healthcare","tag-rural-hospitals","tag-tenncare","tag-tn-5"],"yoast_head":"\nMedicare fraud: who is actually cashing in<\/title>\n<meta name=\"description\" content=\"Republicans rant about Medicare fraud, but the real money is private Medicare Advantage plans overbilling taxpayers. 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