06/10/2026    Paul Kesselman, DPM

Reports on More Fraud by Contractors

Two recent reports continue to illustrate the
significant amount of fraud, abuse at the level of
contractors, NOT physicians or suppliers. The
first is the State of Massachusetts is suing UHC
over alleged $100M in fraudulent Medicaid
payments. Having read the summary of the
complaint, it appears that for over the last
decade UHC has been involved in data mining and
billing CMS for higher levels of care, than were
actually provided. The full story can be found at
https://www.beckerspayer.com/legal/massachusetts-
sues-unitedhealthcare-over-alleged-100m-in-
fraudulent-medicaid-payments/?
origin=PayerE&utm_source=PayerE&utm_medium=email&u
tm_content=newsletter&oly_enc_id=2558E3860112B6W

The second is a report from the OIG entitled: “CMS
Potentially Overpaid Medicare Advantage
Organizations $462 Million Based on Certain
Unsupported Acute Stroke Diagnosis Codes”
The OIG Found the following:

• For all 97 sampled enrollees, the high-risk
acute stroke diagnosis codes that MA organizations
submitted to CMS were not supported by the medical
records associated with the physician data records
containing the diagnoses.
• On the basis of our sample results, we estimated
that CMS made $462 million in potential net
overpayments to MA organizations for 2021.

The OIG report can be found at:
https://oig.hhs.gov/reports/all/2026/cms-
potentially-overpaid-medicare-advantage-
organizations-462-million-based-on-certain-
unsupported-acute-stroke-diagnosis-codes/
Healthcare providers almost universally continue
to claim that until the insurance industry is held
as accountable as nefarious providers and
telemarketers, the abuse by the insurance industry
will continue unabated. Apparently, that seems to
be the truth.

CMS continues to boast how much they allegedly
recover from criminal providers and how much
prison time and banishment from public programs
these individuals will face. Please remind me how
much the insurance industry has illegally been
paid as compared to their fines? Please remind me
when a high-level health care executive was sent
to prison and forced to pay these $ back? Please
advise me how much the insurance industry has
donated to political officials who vote on the
very contracts enriching the insurance executives,
stockholders, etc. Please remind me when the last
time one carrier was not only fined but that state
govt banished the carrier as they would a
provider?

There is simply no accountability for these
individuals. Until that happens one can easily
conclude there will continue to be high levels of
abuse by the insurance industry.

Paul Kesselman, DPM, Oceanside, NY

There are no more messages in this thread.