UnitedHealth Outdoctors The Government

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.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “UnitedHealth Outdoctors The Government

  1. tad hominem
    May 23, 2017 at 4:13 pm

    Trust us, we’re businessmen! We have a fiduciary obligation to our shareholders to do what is in the best, short-term interest of the corporation! and more such drivel from the lying lips of lying businessmen / women lying for the shareholders. For profit corporate medicine on this scale can never be trusted to do anything but cut corners, rig the scales and game the system. I estimate fine of $50 million plus clawback of estimated overcharges. still a drop in the bucket and bet the ceo, cfo and coo will not incur personal losses or penalties.
    No deterrence so they will try again in the future!

  2. john parkin
    May 22, 2017 at 12:46 pm

    UHC has a long history of fines for taking advantage of patients, providers, other payers and even their own stockholders. That’s why they manage to eke out $10 billion yearly. I suspect this is just the proverbial tip of the iceberg.

  3. RSW
    May 22, 2017 at 8:44 am

    And at the same time, physicians are being hounded to death to practice “cost-effective medicine” – every penny we save goes straight to the profit line of these insurance monsters.

  4. Seneca
    May 22, 2017 at 7:37 am

    Ah, crony capitalism at its finest. A local physician overcoded her Medicaid visits and got fined $450K. United probably won’t even get that much penalty.

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