Mr. Poehling’s allegations, if true, could help explain why insurers are staying in the Medicare Advantage program even as they pull out
of the Affordable Care Act exchanges in some states: Medicare Advantage offers a way to get extra money from the federal government.
Mr. Burns also said Mr. Poehling’s complaints and similar ones held UnitedHealth
and other Medicare Advantage participants to higher standards than the ones used by the original Medicare program.
MEDICARE ADVANTAGE PROGRAM
ADDITIONAL PAYMENT TO INSURER FOR SELECTED CONDITIONS
Diabetes without complications
Breast, prostate and other
Diabetes with acute complications
Drug/alcohol dependence
Major depressive, bipolar and
Lung and other severe cancers
Metastatic cancer and acute leukemia
“You or I or the average person is probably appalled by this,” Mr. Poehling said.

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