Medicare Could Have Saved $7.0 Billion in Spending on Select Services Subject to Fraud, Waste, and Abuse if MA Techniques Had Been Employed

BRG professionals evaluated select healthcare services that past government investigations found were subject to fraud, waste, or abuse and found significantly lower rates of utilization among Medicare Advantage (MA) enrollees compared to Traditional Medicare enrollees. MA plans employ fraud detection strategies and medical management tools to protect beneficiaries from unnecessary utilization and spending on services at high risk for fraud, and such techniques could have led to savings in Traditional Medicare had they been employed.

The research and analyses performed in preparing this paper were sponsored by Elevance Health.