Bipartisan Call for Independent Investigation into Medicare Advantage Organizations
On April 16, 2025, Ways and Means Health Subcommittee Ranking Member Lloyd Doggett (D-TX) and Health Subcommittee member Greg Murphy, M.D. (R-NC) called for the Government Accountability Office (GAO) to investigate the vertical consolidation of Medicare Advantage (MA) organizations (MAO) and its impact on Medical Loss Ratio (MLR) calculations. The Members expressed concerns that MAOs may be circumventing MLR regulations, which require large group health insurers, including MA organizations, to spend at least 85% of their revenue on health care services for their beneficiaries. By funneling payments to affiliated businesses, MAOs can categorize a portion of their profits as medical expenses.
The investigation seeks to uncover how MA organizations use taxpayer funding amid their growing ownership of health care businesses and providers. The Members emphasized the need for oversight to address wasteful overpayments and potentially abusive practices. With payments to MAOs reaching $455 billion in 2023, ensuring accountability and transparency in MAO operations is critical to maintaining the integrity of the Medicare program and protecting beneficiaries.
Impact on General Dentistry: MA has seen rapid growth and expansion, covering approximately 54% of Medicare beneficiaries in 2024. Vertical consolidation could present distinct challenges for general dentists, such as restrictive referral systems and patients being directed away from independent practices toward those owned by MA organizations.
The investigation seeks to uncover how MA organizations use taxpayer funding amid their growing ownership of health care businesses and providers. The Members emphasized the need for oversight to address wasteful overpayments and potentially abusive practices. With payments to MAOs reaching $455 billion in 2023, ensuring accountability and transparency in MAO operations is critical to maintaining the integrity of the Medicare program and protecting beneficiaries.
Impact on General Dentistry: MA has seen rapid growth and expansion, covering approximately 54% of Medicare beneficiaries in 2024. Vertical consolidation could present distinct challenges for general dentists, such as restrictive referral systems and patients being directed away from independent practices toward those owned by MA organizations.