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Administrative failures may be driving up the cost of Medicare. April 12, 202615:25 hs Reading 4 min New findings highlight structural pressures within a major federal program, raising concerns about long-term cost sustainability. The long-standing promise of Medicare Advantage has been simple: expanded benefits at a lower cost to taxpayers. But new analysis suggests that the reality may be moving in the opposite direction. A recent report from the Joint Economic Committee (JEC) indicates that administrative practices within private Medicare plans are contributing to higher overall program costs - costs that are ultimately being passed on to beneficiaries. At the center of the issue is a growing gap between the cost of Medicare Advantage and traditional Medicare. According to the report, private plans are now costing the federal government approximately 20% more per enrollee than original Medicare for comparable coverage. This discrepancy is not only affecting federal spending but is also directly influencing the premiums paid by millions of Americans. How overpayments are passed to beneficiaries. The JEC's study, titled "The Part B Premium Pass-Through," outlines how increased spending within Medicare Advantage translates into higher costs for all enrollees. Because Medicare Part B premiums are designed to cover roughly 25% of total program costs, any rise in spending - including overpayments to private plans - automatically results in higher premiums. In 2025, these overpayments increased Part B premiums by an average of $212 per enrollee, adding approximately $13.4 billion in total premium costs. Importantly, these increases affect all beneficiaries, regardless of whether they are enrolled in Medicare Advantage or traditional Medicare. For most seniors, who have their Part B premiums deducted directly from Social Security payments, this dynamic effectively reduces their monthly income. The financial impact is therefore not abstract - it is immediately felt in reduced take-home benefits. Looking ahead, the JEC warns that this "premium pass-through" effect could intensify. By 2035, projections suggest that as much as $450 of an individual's annual Part B premium could be attributed solely to Medicare Advantage overpayments. Administrative drivers behind rising costs. The report identifies two key administrative practices contributing to these higher costs: coding intensity and favorable selection. Coding intensity - often referred to as "upcoding" - occurs when insurers document additional or more severe diagnoses for enrollees, which increases the risk-adjusted payments they receive from the government. Favorable selection, on the other hand, reflects the tendency of Medicare Advantage plans to attract healthier individuals while still receiving payments benchmarked against the higher average costs of traditional Medicare populations. These practices have drawn increasing scrutiny from regulators. In January 2026, affiliates of Kaiser Permanente agreed to a $556 million settlement to resolve allegations brought under the False Claims Act. The U.S. Department of Justice alleged that the organization inflated Medicare Advantage reimbursements by submitting unsupported diagnosis codes and encouraging retrospective documentation adjustments. While the case was settled, no admission of wrongdoing was made. The JEC report suggests that these types of administrative behaviors are central to understanding why Medicare Advantage costs have diverged from expectations. Uneven impact across states. Although Part B premiums are standardized nationwide, the distribution of costs linked to Medicare Advantage varies regionally. States with higher enrollment in private plans - such as Florida (56%), Alabama (59%), and Michigan (62%) - generate a larger share of total overpayments. At the same time, residents in states with lower participation rates, including Wyoming (18%), Vermont (32%), and Alaska (3%), still pay the same premium increases. This creates what the report describes as a form of financial redistribution, where individuals in lower-enrollment states effectively subsidize the enhanced benefits offered in higher-enrollment regions. This imbalance underscores a broader policy concern: while the cost per person remains consistent, the underlying financial flows differ significantly depending on geographic participation patterns. Long-Term implications for Medicare sustainability. The widening gap between Medicare Advantage and traditional Medicare spending raises questions about the long-term sustainability of the program. Without structural changes, the JEC projects that the financial pressure on Part B premiums will continue to grow. This trend is already visible. Part B premiums rose nearly 10% between 2025 and 2026, and projections from the Medicare Trustees suggest premiums could reach $347.50 by 2034. As these costs rise, they place increasing strain not only on beneficiaries but also on the Supplemental Medical Insurance trust fund, which relies on both premiums and general tax revenue. For retirees living on fixed incomes, the stakes are particularly high. Rising premiums directly reduce available income, while broader fiscal pressures may limit future policy flexibility. The findings from the Joint Economic Committee point to a system in need of reassessment. While Medicare Advantage continues to offer expanded benefits and remains popular among enrollees, its current cost structure may be undermining broader program stability. Addressing these challenges will likely require policy changes aimed at aligning payments more closely with actual care costs. Until then, the financial burden associated with administrative inefficiencies may continue to fall on beneficiaries - both directly through premiums and indirectly through the broader tax system. Visit its website for more news __________________________ Disclosure: Some images used in this article were created with artificial intelligence and are for illustrative purposes only. They do not depict real products, brands, or specific situations. Irma León has eight years of professional experience, consolidating four years of experience in in-depth analysis of personal finances and the US economy. She has a bachelor's degree in investigative journalism, giving her a rigorous foundation for documenting and verifying complex data and news. Her field experience is grounded in direct coverage of national and local issues crucial to the American public, including monitoring Social Security policies, the impact of Internal Revenue Service (IRS) regulations, the Fed, Central Bank, and White House, tariffs and consumer prices and regulations, as well as key adjustments to the Medicare, Medigap, and ObamaCare systems, among other healthcare coverage. This commitment is also reflected in immigration issues related to USCIS, personal finances, technology, current events, and direct issues related to mortgages, credit, loans, credit cards, retirement accounts such as Roth plans, 401(k)s, and IRAs, investments, stimulus checks and social programs, travel, discounts and offers, and, of course, the automotive sector. León stands out for his focus on interacting with readers and addressing direct questions from the audience, using these inquiries to guide his in-depth research on policies related to the family economy and what truly interests millions of readers.

Memorial Hermann Health System appoints Desiree Gandrup-Dupre, Senior Vice President, Information Systems Division. Desiree Gandrup-Dupre CONTRIBUTED PHOTO Posted Thursday, April 9, 2026 2:47 pm CONTRIBUTED REPORT Memorial Hermann Health System announced March 30 that Desiree Gandrup-Dupre has been appointed Senior Vice President and Chief Information Officer, effective Apr. 13, 2026. In this role, Gandrup-Dupre will join the system's executive leadership team and lead the operational management of the Information System's Division while advancing the implementation of technologies that elevate high-value care delivery. Recognized for her deep expertise in digital strategy and tech-enabled care ecosystems, Gandrup-Dupre brings more than two decades of leadership in transformational health care technology to Memorial Hermann. "We look forward to welcoming Desiree to Memorial Hermann and the executive leadership team," said Alec King, Executive Vice President and Chief Financial Officer of Memorial Hermann. "Through her leadership, we will further establish our Information Systems Division as an essential partner in enabling technology transformation that supports our patients, physicians and workforce." Gandrup-Dupre joins Memorial Hermann from Kaiser Permanente, where she served as Senior Vice President of Care Delivery and Technology Services, leading large-scale technology transformation initiatives that modernized systems at scale and strengthened integration across care settings. Through her leadership, the system architected an enterprise-wide digital strategy that streamlined patient experiences and improved efficiency for clinical staff. "I am honored to join Memorial Hermann at a time when health care is evolving rapidly," said Gandrup-Dupre. "We have an extraordinary opportunity to accelerate technology transformation that advances care delivery, empowers patients and supports employees." Throughout her career, Gandrup-Dupre has been recognized nationally for her leadership in healthcare technology. She is a five-time CIO 100 Award recipient, a two-time Stevie Award recipient and is a recognized voice at global forums, including Reuters, VIVE, HIMSS and Digital Health Now. Other items that may interest you

Kaiser Permanente begins construction on hospital tower in Oregon. by Gus Iversen, Editor in Chief | April 06, 2026 Kaiser Permanente has started construction on a new hospital tower at its Sunnyside Medical Center in Clackamas, Oregon, with completion expected in 2029. The project will add a seven-story, 615,000-square-foot facility to the campus and is designed to operate as a fully electric hospital, a first in the state. The building is also targeting LEED Gold certification, part of the Oakland, California-based health system's broader sustainability efforts. The expansion is intended to increase capacity and modernize care delivery at the medical center, which first opened in 1975 and now employs more than 2,300 clinicians and staff. The site includes regional programs in neurosurgery, cancer care, cardiovascular services, and a Level III neonatal intensive care unit. MIT labs, experts in Multi-Vendor component level repair of: MRI Coils, RF amplifiers, Gradient Amplifiers Contrast Media Injectors. System repairs, sub-assembly repairs, component level repairs, refurbish/calibrate. [email protected]/+1 (305) 470-8013 According to Kaiser Permanente, the new tower will include private patient rooms throughout, expanded emergency department capacity, and updated surgical and imaging capabilities. Plans also call for integrated telemedicine functionality and redesigned clinical spaces aimed at supporting team-based care. "This new hospital tower is a direct investment in their ability to continue that work," said Leong Koh, M.D., executive medical director of Northwest Permanente. "Designed for team-based care, advanced technology, and a healing environment, it will give our patients the privacy, safety, and comfort they deserve while supporting our clinicians in delivering the best possible outcomes." The project reflects a growing focus among health systems on reducing environmental impact through building design and energy use. Kaiser Permanente said the fully electric infrastructure is expected to significantly lower the facility's carbon footprint. Construction is projected to support more than 600 jobs at peak activity. Once the new tower opens, the existing hospital building is expected to be replaced with parking and outdoor spaces. Sunnyside is one of two Kaiser Permanente hospitals serving Oregon and southwest Washington, alongside Westside Medical Center in Hillsboro.