‘Why $13B to the frauds?’: AOC grills RFK Jr over medicare advantage payments to UnitedHealth

Added: 2026-05-05

[00:00:00]United, CVS-Aetna, they're defrauding the American public to the tune of $80 billion a year.

[00:00:06]We know that they're doing this to the public. You know it, I know it. I was surprised to see about 2 weeks ago, you had decided to give them another $13 billion.

[00:00:17]Why did you do that?

[00:00:19]We have to look at the reimbursements that the industry got, which they said they were going to 5% increase in cost.

[00:00:27]They are upcoding. They are telling us, the public, the government, Medicare, our systems, that people are sicker than they are so that they can get more money.

[00:00:37]We are giving them more money because they're saying Yeah, they're lying. But my job as HHS Secretary I have to balance Thank you, Madam Chairwoman. How you doing, Mr. Secretary?

[00:00:52]>> Good.

[00:00:53]>> [laughter] >> Thank you for asking.

[00:00:54]>> Of course, of course. Um I'm not sure if you remember our last chat about a year ago where we talked about Medicare Advantage.

[00:01:06]Um, but you know, I think one area of agreement that we have, I hope, is that these insurance companies are fleecing the public, right? Can we Can we agree on that? Absolutely. And they are I mean, it's highway robbery on the American people, on people who are sick, on seniors. We're on the same page about that, right? Yes. And last year, I brought up Medicare, the Medicare Advantage program to you because these corporations like United Healthcare, Aetna, are known to be defrauding the public. And really, we know that with Medicare Advantage, it's to the tune of about $80 billion.

[00:01:50]Um, and the Department of Justice has in fact opened it it an actual >> United last time. So, you remember this, right? Okay, I'm glad that that we're able to kind of jog the memory on there.

[00:02:02]We chatted about this. We actually chatted about it afterwards, too.

[00:02:06]Um, and so, we know this. We're all on the same page here. At United, CVS-Aetna, they're defrauding the American public to the tune of $80 billion a year.

[00:02:19]We know that they're doing this to the public. You know it, I know it. We've even had some bipartisan chat about this.

[00:02:25]And so, I was surprised to see about 2 weeks ago, um, you had decided to give them another $13 billion.

[00:02:35]And it was used through the mechanism of the MA reimbursement rates.

[00:02:40]Uh, but I want to know why did you do that?

[00:02:45]And first of all, I agree with you on everything that you said. Um, we you know, we have to look at the reimbursements that the industry got, which they said they were going to 5% increase in cost.

[00:03:00]And that if we didn't give them the full 5%, they were going to lose they were that it would impair patient choice, particularly in some regions of the country. The industry would leave.

[00:03:10]We gave them a 2% raise.

[00:03:12]>> Right. And I I hear what you're saying, Mr. Secretary, that the industry is saying that they're increasing these costs.

[00:03:22]But the industry is defrauding the public.

[00:03:27]So, we know they're lying.

[00:03:30]Uh, we know they're lying through even their mechanisms. They are upcoding.

[00:03:35]They are telling us, the public, the government, Medicare, our systems, that people are sicker than they are so that they can get more money. They're lowering their reimbursement rates.

[00:03:45]They're increasing denial. So, we know that these folks are lying.

[00:03:51]We know that they're bad actors.

[00:03:55]And if I'm hearing you correctly, we are giving them more money because they're saying that they need it?

[00:04:05]Uh, can I answer the question?

[00:04:07]>> Yeah.

[00:04:08]First of all, I appreciate everything you've done and you speaking out about upcoding. We are ending upcoding. We're using AI now to detect it, to prosecute it, and to end it.

[00:04:20]Yeah, they're lying. But my job as HHS Secretary I have to balance the impact on patients if there are no options in those areas.

[00:04:34]So, we do a we do a lot of verify. We don't trust.

[00:04:39]We do a lot of verify.

[00:04:40]>> what you're saying. I mean, even when you talked about that 2%, I something that I found interesting, too, because that 2.48% wasn't initially what you were going to go for. You had announced in January that uh, in fact, CMS had proposed an increase of 0.09%.

[00:04:59]Yeah. Which would have essentially kept payments flat at minimum to these corporations like United and Aetna that are robbing us.

[00:05:12]And so, there was an interesting amendment that you had made. We've got the experts saying, "Okay, even when you start looking at that inflation rate or or that cost rate, even that at most is 0.09%."

[00:05:24]But then, it seemed as though there was some industry backlash.

[00:05:30]And now we're at 2.48%.

[00:05:34]Um we're giving them $13 billion when they are stealing $80 billion a year as it is.

[00:05:43]I say we let them eat it.

[00:05:45]Why not?

[00:05:47]Well, you can see from what we originally published what our intention was, to give them essentially nothing.

[00:05:53]Okay.

[00:05:54]>> Um, and we got a huge blowback not only from the industry, but providers and everybody else who said we are going to experience closures.

[00:06:03]We're going to experience places where you cannot get insurance. It is going to leave all these patients high and dry.

[00:06:10]We did our own investigation. And you know, you can look at healthcare because you can increase the amount >> And you can I really appreciate you giving me a chance to answer questions.

[00:06:22]I I I I can't thank you enough for that.

[00:06:24]Okay. Appreciate it. Bye. Thank you.

[00:06:27]>> We'll hear more about that. Now, I recognize Representative Halchin for her 5 minutes of questioning.

[00:06:33]Thank you, Madam Chair. Thank you, Mr. Secretary. Um, appreciate your patience today. Uh Uh, an issue that has been consistently brought to my attention is the vital need to simplify and expedite the FDA approval process for pharmaceutical manufacturers who already are operating in the United States or seeking to expand operations in the United States.

[00:06:56]Uh, this is part of the Biomedical Advancement Research and Development Authority trying to um expedite our um national security for um manufacturing medicines here in the United States. Indiana is a national leader in pharmaceutical production and exports, and the industry continues to expand its research and development. In the last couple of years alone, Eli Lilly and Company, Roche Diagnostics, and Novartis have announced billions of dollars of investments in manufacturing facilities and drug development.

[00:07:31]Ariva Pharmaceuticals is a critical manufacturer of generics in my district, which I'm proud to have headquartered in Southern Indiana. And they've been manufacturing pharmaceutical products in Indiana since 2011. They're continuing their efforts to expand production to include manufacturing of raw materials.

[00:07:49]They make fludarabine phosphate, which is a key pretreatment for CAR T-cell therapy and stem cell therapy for cancer treatment.

[00:07:58]The only place they can source uh the precursor to make that medication is in Wuhan, China.

[00:08:06]Um, they are facing a lengthy and complicated approval process with uncertain timelines, making it extremely difficult to expand these productions in raw materials.

[00:08:17]Uh, Mr. Secretary, what are HHS and the FDA doing to accelerate US pharmaceutical domestic manufacturing of these precursors and minimizing regulatory roadblocks while still maintaining high safety standards? And thank you for asking me that. It's been a huge stumbling block for the production of generic drugs in this country, which are the majority of drugs that we use. And we're getting them all from China and from India.

[00:08:45]Almost all of them from China and India.

[00:08:47]And it is a vulnerability in our supply chain. It's a national health threat, a national defense vulnerability as well. So, we're doing everything that we can to uh to ease the production pains of construction and expanding plants here and getting quick approvals. We have a new FDA has initiated a new program called the pre-check program that fast tracks these proposals. I'm happy to talk to you or to the people who run this plant um to make sure that they're aware of that program and that they can take advantage of it. Thank you. And in when we're talking about the cost of medicines in the United States as well, just importing that precursor is $40,000 in shipping. Uh, so it would be great to for the cost of our prescription drugs here, particularly for cancer treatment, to reduce those costs by helping to onshore that manufacturing. I want to switch now to an issue the issue of long COVID. Um long COVID.

[00:09:52]>> Yeah. Um we believe that as many as 44 million people could be affected by long COVID.

[00:10:00]The more times you get COVID, the more likely you are to develop that. There is research ongoing, including treatment for long COVID, which can be very debilitating to some Americans. I just want to encourage additional attention and research into long COVID for treatment for that.

[00:10:19]I'm I have some concerns that fibromyalgia might be being diagnosed rather than long COVID and would be grateful having a family member who has experienced that to um to just encourage you to continue focus on research for the treatment and diagnosis of long COVID.

[00:10:40]I mean, we are putting a This is a priority for me personally. I have a son who is really was debilitated by long COVID.

[00:10:51]We have had round table at HHS for the first time in history. We brought in the best experts around the country, people like Jordan Vaughn from New Jersey and the best people who are have the most experience at treating it successfully from California, from all over the country.

[00:11:09]And we are targeting diagnostics to make sure that there's uniform diagnostics of very, very complex illness and manifest differently in almost every person.

[00:11:23]Treatment protocols are different in people. There is no panacea.

[00:11:28]And but there are biomarkers that can tell us what kind of treatments work best for what populations. Thank you.

[00:11:36]>> And [clears throat] we're working on identifying those biomarkers, matching them with the treatment, and then getting the patients together with the appropriate physician.

[00:11:45]>> Okay. Thank you. My time's expired. I appreciate your service and leadership, Mr. Secretary.