COMMENTARY: Republicans have found $124B in Medicare fraud. Now what?

Republicans have found $124 billion in wasteful Medicare spending that enriches insurance companies at the expense of seniors and taxpayers. The only question is if they’ll take the savings or concede the insurance lobby’s claim that all efforts to rein in waste, fraud and abuse are “Medicare cuts.”

This choice will define Republican credibility on government waste for years to come. The opportunity is concrete and bipartisan.

The No UPCODE Act, introduced by Sen. Bill Cassidy, R-La., and Sen. Jeff Merkley, D-Ore., would directly attack Medicare overbilling. It ensures that patients are diagnosed by doctors, not insurance companies looking to maximize payments.

Here’s how the fraud works: Medicare pays insurers more when patients appear sicker on paper. Insurers respond by adding diagnoses that doctors never made to get higher government payments.

UnitedHealthcare, the nation’s largest Medicare Advantage insurer, is under federal investigation for this.

The Congressional Budget Office estimates that stopping it would save taxpayers $124 billion over the next decade.

Cassidy, a physician, frames the stakes clearly: “The Medicare Trust Fund is going bust in eight years.”

For anyone concerned about fiscal responsibility, this should be straightforward. President Donald Trump has repeatedly called for eliminating Medicare waste, yet the bill has stalled in Congress. Insurance companies have mobilized an intense lobbying campaign to stop it.

UnitedHealthcare doubled its Washington spending to $7.7 million in the first half of 2025. Its strategy is to reframe anti-fraud measures as “Medicare cuts” to intimidate Congress into inaction.

In reality, stopping fraud means that more funds are allocated to patient care rather than insurance company profits. Several key Republicans recognize this opportunity.

Senate Finance Chairman Mike Crapo, R-Idaho, supports the bill, joined by GOP colleagues Roger Marshall of Kansas and Mike Rounds of South Dakota. Mehmet Oz, now leading the Centers for Medicare and Medicaid Services, has announced expanded auditing to “crush fraud, waste and abuse.”

Yet, Republicans know insurance companies will spend millions portraying any action as an assault on seniors.

This playbook has protected wasteful spending for decades.

Insurance companies wrap their schemes in claims about protecting vulnerable populations.

The stakes are high for Republicans who campaign on fiscal responsibility. Sen. Rand Paul, R-Ky., recently lamented that Republicans “once knew how to fix the deficit” but are now “losing the battle.”

When both parties agree that spending is a problem, obvious solutions shouldn’t be ignored. Medicare beneficiaries gain nothing from overbilling schemes except higher premiums and weakened program solvency.

The insurance industry’s fierce resistance exposes what’s at stake — protecting billions in unearned profits.

Eliminating overbilling would force insurers to compete on efficiency and quality of care rather than gaming payment formulas.

This represents precisely the kind of accountability that reasonable governance demands. The No UPCODE Act offers everything Republicans want: a better Medicare program and more savings for seniors and taxpayers.

The only question is whether they’ll take the win or get cowed by one of America’s least trusted industries.

Mark Merritt is a health policy expert who has worked at several health organizations. He wrote this for InsideSources.com.