AOC grills RFK Jr.

Rep. Alexandria Ocasio-Cortez used an April 21 House hearing to press Health and Human Services Secretary Robert F. Kennedy Jr. over higher Medicare Advantage payments to private insurers. (youtube.com) The exchange came during a House Energy and Commerce Committee hearing, where Ocasio-Cortez tied the administration’s policy to insurers she said were under fraud scrutiny. Forbes’ hearing clip identifies UnitedHealth Group as the company at the center of her questions. (youtube.com) Medicare Advantage is the private-plan version of Medicare, and insurers are paid more when members are coded as sicker. The Centers for Medicare & Medicaid Services said on April 7, 2025 that payments to Medicare Advantage plans were expected to rise 5.06% in 2026, or more than $25 billion. (cms.gov) That payment formula is where the fight sits. The Office of Inspector General said diagnoses reported only on health risk assessments and linked chart reviews produced an estimated $7.5 billion in Medicare Advantage risk-adjusted payments for 2023, with no other 2022 service records supporting those diagnoses for 1.7 million enrollees. (oig.hhs.gov) The Inspector General said in-home assessments and linked chart reviews generated nearly two-thirds of that $7.5 billion. It also said just 20 Medicare Advantage companies accounted for 80% of the payments in question. (oig.hhs.gov) The American Hospital Association, summarizing the same federal report, said UnitedHealth Group and Humana accounted for more than $5.4 billion of the $7.5 billion estimate. That gave lawmakers a concrete target when they argued that higher plan payments were rewarding aggressive coding. (aha.org) Congressional pressure on the program was already building before the hearing. In a March 27, 2025 letter to Kennedy and the Centers for Medicare & Medicaid Services, 43 House Democrats said Medicare Advantage cost 22% more per enrollee than traditional Medicare in 2024 and cited an estimate of at least $83 billion in overcharges. (jayapal.house.gov) Federal enforcement has also widened beyond one company. On May 1, 2025, the Justice Department sued Aetna, Elevance, Humana and three broker organizations, alleging illegal kickbacks tied to Medicare Advantage enrollments and discrimination against disabled beneficiaries. (justice.gov) UnitedHealth has said it disputes allegations about its Medicare practices. In a July 24, 2025 securities disclosure, the company said it was complying with criminal and civil Justice Department requests and had “full confidence” in its practices. (abcnews.com) Kennedy’s department has defended the 2026 rate notice as a routine annual update based on newer fee-for-service spending data. Ocasio-Cortez’s question at the hearing was whether a routine update should still go forward when federal auditors and prosecutors were already examining how some insurers get paid. (cms.gov)