What All These Health Insurance Investigations Are Really Telling Us

You’ve probably seen the headlines by now. DOJ, FBI, HHS, even the FTC. Everyone seems to be investigating the big health insurance carriers.

But here’s the question no one’s really asking:

Will any of this actually change anything?

Dr. Eric Bricker broke it down in a recent Healthcare Z episode, and it’s worth taking a closer look. Because what’s happening behind the scenes paints a much bigger picture than a few press releases.

Who’s Getting Investigated?

• UnitedHealth Group is under investigation by the DOJ and FBI for allegedly inflating diagnoses in their Medicare Advantage population to overbill the government.
• CVS/Aetna is being looked at by multiple federal agencies. The allegation? They paid kickbacks to brokers to avoid enrolling high-risk patients who might cost more.
• Humana, Anthem, and Elevance are caught up in similar accusations.
• Cigna already went through it. They settled a case last year over the same kind of behavior.
• PBMs are still being investigated by the FTC for practices that might be driving up prescription drug costs.

The common thread in all of this is Medicare Advantage. These carriers are making billions from the federal government. The more "sick" their members look on paper, the more money they make.

But here’s the kicker.

These insurance companies actually make more from Medicare than they do from employers.

That makes them more like government contractors than private insurers. Think Boeing. Think Lockheed Martin. And just like the defense industry, these companies have a long history of overbilling with little consequence.

So is this going to lead to real change?

Probably not.

What Actually Drives Change?

Dr. Bricker points to something important. The defense industry didn’t change because of investigations. It changed because of competition.

New players like SpaceX and Palantir brought fresh ideas, better technology, and forced the legacy players to evolve. That’s what really moved the needle.

Healthcare might follow a similar path. Change won’t come from top-down investigations. It’ll come from bottom-up innovation.

What This Means for Employers

If you’re offering group health insurance, you’re already paying the price for how this system works. The more opaque it is, the more you and your employees overpay.

But there are better options out there.

The system won’t fix itself. But employers and advisors who start asking better questions and demanding more transparency can help shift the landscape.

So here’s the real question.

Are you still playing by the old rules? Or are you open to a better way?

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