May 08, 2025

Warren, Wyden, Doggett, Schakowsky Push Congressional Leadership to Reject Medicaid Cuts, Crack Down on Medicare Advantage Upcoding

 Congressional Republicans’ current plan sets them up to slash hundreds of billions from Medicaid and CHIP

Lawmakers cite bipartisan support for cracking down on waste, fraud, and abuse in Medicare Advantage

Letter from House (PDF) | Letter from Senate (PDF)

Washington, D.C. – As Congress considers reconciliation legislation, Senator Elizabeth Warren (D-Mass.), Senator Ron Wyden (D-Ore.), Ranking Member of the Senate Finance Committee, along with Representatives Lloyd Doggett (D-Texas) and Jan Schakowsky (D-Ill.) led their colleagues in writing to Senate Majority Leader John Thune and Speaker of the House Mike Johnson, urging them to crack down on waste, fraud, and abuse in Medicare Advantage (MA) instead of forging ahead with cuts to Medicaid.

“As Congress considers reconciliation legislation, we urge you to reject cuts to Medicaid, which are deeply unpopular and will rip away health care from millions of Americans,” wrote the lawmakers. “Where there is widespread agreement is the need to address waste, fraud, and abuse by private, for-profit insurance companies. We write to urge you to crack down on the growing threat to the Medicare program known as ‘upcoding.’”

Upcoding is the practice by which private insurers in Medicare Advantage exaggerate the medical diagnoses of their enrollees to secure higher payments from the federal government. This results in wasteful spending in Medicare, overcharging seniors and taxpayers while adding tens of billions in costs to the federal government. Analysis from the non-partisan Medicare Payment Advisory Committee (MedPAC) found that upcoding is expected to increase Medicare payments to private health insurance companies by an estimated 10 percent, or $40 billion, in 2025.

This waste, fraud, and abuse has been called out by both Democrats and Republicans. CMS Administrator Mehmet Oz even noted that tackling this fraud “is relatively enjoyable to go after, because … we have bipartisan support.” Senator Chuck Grassley (R-IA) has launched an inquiry into UnitedHealth’s billing practices in Medicare Advantage, and Senator Bill Cassidy (R-LA) supports the No UPCODE Act, which would ban some of the most aggressive forms of upcoding by private insurers in the program.

“The Wall Street Journal, MedPAC, Administrator Oz, and Congressional Republicans all seem to agree: wasteful spending in MA, driven by abusive upcoding practices, are a ‘more rational’  route to securing health care savings that will benefit the Medicare program and taxpayers,” continued the lawmakers. “Your directive to cut federal health care spending should come from reducing waste, fraud, and abuse like upcoding by for-profit insurance companies, not by cutting health care benefits for American families who rely on Medicaid to make ends meet.”

Nevertheless, Congressional Republicans are forging ahead with plans to slash hundreds of billions of dollars from Medicaid and the Children’s Health Insurance Program (CHIP)  – which will put health and livelihoods at risk for the nearly 80 million Americans, including 37 million children, eight million people with disabilities, and seven million seniors covered by these programs

“If there is no course correction that protects Medicaid, tens of millions of Americans will be kicked off their health care,” wrote the lawmakers. “We urge you instead to listen to Administrator Oz and tackle real fraud, waste, and abuse by private, for-profit health insurers in MA.”

The letters were also signed by Senators Bernie Sanders (D-Vt.), Tina Smith (D-Minn.), and Senator Jeff Merkley (D-Ore.), as well as Representatives Hank Johnson (D-Ga.), Mark Pocan (D-Wis.), Adam Smith (D-Wash.), Ayanna Pressley (D-Mass.), Joaquin Castro (D-Texas), Rashida Tlaib (D-Mich.), Summer Lee (D-Pa.), Nydia Velazquez (D-N.Y.), Betty McCollum (D-Minn.), Al Green (D-Texas), John Garamendi (D-Calif.), Lateefah Simon (D-Calif.), Alexandria Ocasio-Cortez (D-N.Y.), Eleanor Homes Norton (D-D.C.), Raja Krishnamoorthi (D-Ill.), Pramila Jayapal (D-Wash.), Delia Ramirez (D-Ill.), Ilhan Omar (D-Minn.), Mark Takano (D-Calif.), Danny Davis (D-Ill.), Steve Cohen (D-Tenn.), Maxwell Frost (D-Florida), Chuy Garcia (D-Ill.), Sylvia Garcia (D-Texas), Greg Casar (D-Texas), Bonnie Watson Coleman (D-N.J.), Chris Deluzio (D-Pa.), Jill Tokuda (D-Hawaii), Val Hoyle (D-Ore.), Shri Thanedar (D-Mich.), Andre Carson (D-Ind.), Adriano Espaillat (D-N.Y.), Marcy Kaptur (D-Ohio), and Melanie Stansbury (D-N.M.).

The letters have been endorsed by the Center for American Progress, Center for Medicare Advocacy, LeadingAge, P Street Project, Protect Our Care, Families USA, and Public Citizen. 

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