There Is a Better Way: Congress Can Cut Up to $1T in Waste, Fraud, and Abuse

Address Overpayments to Medicare Advantage Plans and Enact Site-Neutral Payments

WASHINGTON, D.C. (June 26, 2025) – Statement from Mark E. Miller, executive vice president of health care at Arnold Ventures, following the news of the Senate parliamentarian’s Medicaid determination.

“The parliamentarian’s determination that key Medicaid policy provisions in the Senate reconciliation bill do not comply with budget rules should serve as a wake-up call to Congress. America faces a profound fiscal crisis, yet once again, policymakers are confronted with the limits of relying on coverage cuts to achieve savings. It is time to stop kicking the can down the road. 

“There is a better way — one that protects patients while delivering real savings. At Arnold Ventures, we have identified 2 commonsense reforms Congress can adopt immediately to reduce waste, fraud, and abuse in the Medicare program. These 2 reforms would save more than $1 trillion over the next decade while protecting coverage, lowering Medicare premiums, and reducing out-of-pocket patient costs.

“First, Congress should reform risk adjustment in Medicare Advantage to address the well-documented abusive and, in some cases, fraudulent billing practices insurers use to game the system and increase their Medicare payments. If left unaddressed, 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.

“Second, Congress should enact site-neutral payment policies, ending arbitrary overpayments so Medicare is not paying up to 4 times 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 the same doctor delivers it. 

“Congress must seize the opportunity that the One Big Beautiful Bill (OBBB) provides and deliver meaningful reform that reins in abuse by special interests, strengthens Medicare, and protects Americans.”