No UPCODE Act Targets $124 Billion Medicare Overbilling to Save Taxpayers

The No UPCODE Act, supported by bipartisan lawmakers including Sen. Bill Cassidy and Sen. Jeff Merkley, targets Medicare overbilling practices that inflate payments to insurance companies such as UnitedHealthcare.

This legislation aims to curb fraudulent diagnoses added by insurers aiming to increase Medicare reimbursements, a practice that contributes to $124 billion in excess spending over the next decade. The proposed reforms focus on ensuring diagnoses are made by physicians rather than insurers, thereby protecting Medicare’s financial integrity. UnitedHealthcare is currently under federal investigation for such practices, highlighting the scrutiny over these billing strategies. Insurance companies are actively lobbying against the bill, framing anti-fraud measures as harmful cuts to Medicare, which has led to delays in the bill’s progress despite support from key Republican senators like Senate Finance Chairman Mike Crapo and others. CMS Administrator Mehmet Oz’s commitment to expanding fraud audits aligns with this legislative effort. These overbilling schemes result in higher premiums for beneficiaries and reduce the program’s long-term solvency by prolonging wasteful spending.

Eliminating such practices would pivot competition among insurers towards efficiency and quality of care rather than manipulating payment structures. The issue tests the Republican Party’s stance on fiscal responsibility and government waste reduction, with significant implications for Medicare’s future sustainability and taxpayer savings.