Congressional Leaders Can Cut up to $1T in Waste, Fraud and Abuse by Addressing Overpayments to Medicare Advantage Plans and Enacting Site-Neutral Payments

Statement from Mark E. Miller, executive vice president of health care at Arnold Ventures on recent comments from Senate leadership.

Washington, D.C. (June 5, 2025) –

“Today Senate leaders and the administration expressed openness to ​‘rooting’ out waste, fraud, and abuse in any government program. This sentiment comes as welcome news, as there is more than enough unnecessary and fraudulent spending across our health care system for Congress to meaningfully reduce spending without jeopardizing coverage or access to high-quality care.

“At Arnold Ventures, we have identified two areas where Congress can make targeted reforms to lower Medicare spending and rein in the abusive practices that special interests use to enrich their profits at the expense of seniors and people with disabilities:

• Modifying risk adjustment in Medicare Advantage (MA) to address the well-documented abusive and, in some cases, fraudulent billing practices insurers use to game the system and increase their Medicare payments. These practices will result in $40 billion in overpayments to health plans in 2025 alone and increase the premiums paid by all Medicare beneficiaries by $13 billion.
• Enacting site-neutral payments so Medicare isn’t paying up to 4x more for the same service based on where care is received. When hospitals buy up physician practices, they charge taxpayers and Medicare beneficiaries more for the exact same care, even when it’s delivered by the same doctor.

“These reforms alone would achieve substantial savings for taxpayers — totaling more than $1 trillion over 10 years. They would also lower premiums for people on Medicare, and in the case of site-neutral payments, reduce their out-of-pocket costs when they receive care. Congress can create greater efficiencies, cut costs, and protect patients, and they should not miss the chance to do so.”