Beware new Medicare scheme


To the editor:

In 2019, Medicare quietly launched a scheme called “direct contracting,” allowing insurance companies to control the health care of tens of millions of traditional Medicare and Medicare supplement beneficiaries.

Direct contracting inserts a for-profit company between patients and medical providers. Companies are paid a monthly fee to cover a portion of a patient’s expenses, keeping 40 percent of the fee that’s not spent on patient care. 

Beneficiaries can be enrolled without their full knowledge or consent. And to opt out, a patient must change their primary care doctor.

Companies lure doctors with promises of greater reimbursement from Medicare and payments for enrolling their patients into the plan. Companies were granted a waiver that exempts them from certain anti-kickback regulations that normally keep doctors from entering their patients in a for-profit plan, so doctors can be paid to enroll their patients in the scheme even without the patient’s permission.

The program has no congressional input, approval or oversight. The general counsel for the U.S. Health and Human Services Department warned that it appeared the new project was set up to benefit specific companies.

Since resigning from Medicare, two officials involved with planning the scheme have opened businesses that will benefit from direct contracting.

Medicare admits previous attempts to save money and improve care have failed, costing taxpayers tens of billions of dollars. Instead of cancelling the program, Medicare recently renamed the scheme, calling it ACO Reach, but the same flaws exist.

Medicare expects to cover all traditional Medicare beneficiaries with this plan by 2030, effectively privatizing Medicare.

If the ACO Reach program continues, senior citizens will have their care radically changed, their choices undermined, services denied, and care rationed while increasing the chance of bankrupting Medicare.

Health care should be between patients and their doctors, not companies that have profit as their motive.

Mike Gatton

Mike Gatton, Medicare, scheme, U.S. Health and Human Services Department,