The Justice Department on Tuesday has accused UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans. They are alleging “that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved.” How does this happen? Well, Medicare pays the health plans using a complex formula called a risk score, which is supposed to pay higher rates for sicker patients than for people in good health. It seems UnitedHealth repeatedly ignored findings from its own auditors that risk scores were often inflated.
The lawsuit cites more than a dozen examples of undocumented medical conditions, from chronic hepatitis to spinal cord injuries. At one medical group, auditors reviewed records of 126 patients diagnosed with spinal injuries. Only two were verified, according to the complaint.
It never ceases to amaze me how greedy these insurers are. They do NOT lose money. Sure they got a little squeezed by the ACA but they had exit guarantees that made the move less risky. Add to this that they raised ALL the rates outside of the exchange and they won big. You can see their profits and their stock prices if you don’t believe me. But that wasn’t enough. They had to cheat even more by making patients “sicker” then they are or by making up diagnoses when they needed to.
I guarantee they pay a minimal fine for this when it is all said and done. And the taxpayers will lose again.