Why It Matters

Medicare Advantage faces a crisis driven by bipartisan accusations of systemic overpayment and fraud. Congress is advancing multiple reform bills targeting the program’s core operational practices—from improper diagnosis coding that inflates government payments by an estimated $1.2 trillion over the next decade, to AI-driven claims denials, ghost networks, and delayed provider payments. The Department of Justice is investigating UnitedHealth Group’s billing practices, lawmakers have equated MA overpayments with fraud, and regulatory agencies are tightening audit and network verification standards.

By the Numbers

The Better Medicare Alliance‘s $500,000 Q3 2025 lobbying investment reflects the urgent need to shape legislative outcomes—or face significantly more restrictive regulations.

The Better Medicare Alliance has accumulated $10.65 million across 82 disclosures since mid-2017, splitting advocacy between $8.66 million in in-house operations and external firms including Squire Patton Boggs and Capitol Hill Consulting Group.

BMA’s Q3 2025 in-house disclosure totaled $500,000, focused on Medicare/Medicaid issues spanning prior authorization reform, risk adjustment, provider payments, and network adequacy. The three-person team includes Christopher M. Long (former AHIP and Kaiser veteran), Jennifer Nord Mallard (former American Hospital Association and Mayo Clinic representative), and MacKenzie H. Banks, who brings Capitol Hill experience from internships with Rep. Peter DeFazio (D-OR-4) and Rep. Rosa DeLauro (D-CT-3).

The Agenda

BMA is defending MA program practices against mounting congressional scrutiny across multiple fronts. On prior authorization, the group engages on the Gold Card Act of 2023 and Improving Seniors’ Timely Access to Care Act. On risk adjustment, BMA opposes the No UPCODE Act, which targets alleged overcoding practices.

The organization also lobbies on provider payments through the Medicare Advantage Prompt Pay Act, network adequacy concerns including rural provider access, and supplemental benefits transparency. BMA remains active on dual-eligible beneficiaries through the DUALS Act of 2024 and broader health issues including telehealth extension and provider directory accuracy.

Broader Context

The Congressional Budget Office estimates MA will be overpaid by $1.2 trillion through 2034, while MedPAC data shows taxpayers spent $83 billion more on MA enrollees than traditional Medicare in 2024. Recent developments creating urgency include Senator Richard Blumenthal questioning major MA insurers about AI-driven claims denials, the DOJ investigation of UnitedHealth Group’s billing practices, and OIG findings that 55% of MA plan providers were inactive.

Between The Lines

Congress is moving aggressively across multiple fronts. The Improving Seniors’ Timely Access to Care Act targets prior authorization burdens with stricter timelines. The bipartisan No UPCODE Act, championed by Sens. Bill Cassidy (R-LA) and Jeff Merkley (D-OR), aims to curb improper diagnosis coding. Democrats have intensified scrutiny, with Sen. Elizabeth Warren condemning upcoding as fraud and Sen. Ron Wyden calling for MA agents to become fiduciaries.

Competitive Landscape

SCAN Health Plan, Triple-S Management Corp., and UnitedHealth Group are coordinating industry-wide efforts to defend the current MA business model. The breadth of coordination suggests insurers view this legislative moment as existential, requiring unified defense against bipartisan reform targeting prior authorization, risk adjustment, provider payment standards, and network adequacy.

The Bottom Line

BMA’s $500,000 Q3 spending reflects an industry under sustained attack, with lawmakers from both parties now treating MA overpayments as a fiscal and consumer protection priority rather than routine policy debate. The organization’s team is engaged across nearly every major reform bill, defending against allegations that have attracted DOJ investigations and bipartisan congressional momentum for comprehensive program overhauls.