This episode of "The Journal" investigates the Medicare Advantage program, a private insurance alternative to traditional Medicare, focusing on issues of denied coverage and potential fraud. The report highlights a case where a 96-year-old woman was denied nursing home coverage by her Medicare Advantage plan, later covered by traditional Medicare after switching. The investigation reveals a pattern of patients switching from Medicare Advantage to traditional Medicare at the end of life, costing insurers billions and shifting the burden to taxpayers. Government scrutiny and investigations into major insurers like UnitedHealth Group are increasing due to concerns about billing practices and unnecessary diagnoses, raising questions about the efficiency and effectiveness of the Medicare Advantage program.
