At the time when Congress launched the Medicare Advantage program concept several decades ago, the theory in place was insurers would make Medicare more efficient, have an incentive to keep patients healthier and probably save money for the government in the process.

Those at the forefront of promoting the concept at that time probably never in their wildest dreams anticipated that one day a major, well-respected national newspaper would have on its front page the headline “Medicare paid $50 billion to insurers for untreated ills.”

Yet that was the headline in the July 9 edition of the Wall Street Journal that no doubt evoked gasps in many households across the country that have placed their trust over the years in health insurance coverage provided by such plans.

“Private insurers involved in the government’s Medicare Advantage program made hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments from 2018 to 2021, including outright wrong ones … a Wall Street Journal analysis of billions of Medicare records found,” the July 9 article reported.

The lengthy Journal article, which spanned more than a full page, included these paragraphs:

≤ “The questionable diagnoses included some for potentially deadly illnesses, such as AIDS, for which patients received no subsequent care, and for conditions people couldn’t possibly have, the analysis showed. Often, neither the patients nor their doctors had any idea.”

≤ “Instead of saving taxpayers money, Medicare Advantage has added tens of billions of dollars in costs, researchers and some government officials have said.”

≤ “Medicare Advantage has cost the government an extra $591 billion over the past 18 years, compared with what Medicare would have cost without the help of the private plans, according to a March report of the Medicare Payment Advisory Commission, or MedPAC, a nonpartisan agency that advises Congress. Adjusted for inflation, that amounts to $4,300 per U.S. tax filer.”

≤ “The Journal reviewed the Medicare data under an agreement with the federal government. The data doesn’t include patients’ names, but covers details of doctor visits, hospital stays, prescriptions and other care.”

A spokesman for one of the major Medicare Advantage insurers called the Journal’s analysis “inaccurate and biased,” while another provided a statement calling the Journal’s analysis of treatment rates for people with insurer-driven diagnoses “flawed and misleading.”

Perhaps there are some flaws in what the Journal reported; the Journal’s work will continue to be scrutinized on many fronts.

However, more than a dozen experts, including academics, actuaries and policy analysts who the Journal said it consulted about its analysis of the Medicare data said the newspaper’s methodology was sound.

Meanwhile, an insurance industry trade group — AHIP — said in a written statement that audits of Medicare Advantage plans conducted by government contractors have found Medicare Advantage insurers to be highly accurate.

Within something as big as Medicare, it is understandable that some problems might fall through the proverbial cracks. But $50 billion worth? Someone has some serious explaining to do, the sooner the better.

Let the congressional hearings begin.