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Started By
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DOJ goes after United Healthcare
Posted on 2/21/25 at 9:08 am
Posted on 2/21/25 at 9:08 am
Looks like this crux of the probe is pretty fricking scandalous, I bet all the insurers are doing this shite
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Posted on 2/21/25 at 9:11 am to The Egg
Luigi crawled so Bondi could fly
Posted on 2/21/25 at 9:11 am to The Egg
Insurance companies and doctors who have been “coding intelligently” are about to find out
Posted on 2/21/25 at 9:13 am to The Egg
These are medical professionals you're talking about. Only the finest people.
Posted on 2/21/25 at 9:18 am to theunknownknight
long overdue, but i'm sure it's not the first or last probe we'll get into these types of insurance deals
Posted on 2/21/25 at 9:19 am to The Egg
I heard on CNBC this morning that UNH is different than other insurers in that they actually employ physicians. It is these physicians that are under the microscope. At least, that is how I understood it. UNH is arguing that these were preventative services so as to not have to deal with major issues later. Could be all bullshite. 
Posted on 2/21/25 at 9:19 am to theunknownknight
quote:Hope Sunny Hostin's husband gets a 'find out'
Insurance companies and doctors who have been “coding intelligently” are about to find out
Posted on 2/21/25 at 9:21 am to The Egg
2,735 ave cost of fed payment for in home visits.
THATS WHY WE GET SO MANY HOME NURSING CALLS TO SET UP APPOINTMENTS.
We use Aetna Media advantage and they promote the home visit nonsense to the extent we will get several phone calls a week trying to schedule an appointment, even though they know our check up frequency with Pcp, and specialists
THATS WHY WE GET SO MANY HOME NURSING CALLS TO SET UP APPOINTMENTS.
We use Aetna Media advantage and they promote the home visit nonsense to the extent we will get several phone calls a week trying to schedule an appointment, even though they know our check up frequency with Pcp, and specialists
Posted on 2/21/25 at 9:23 am to The Egg
This is great, as healthcare in this counrty has gone rogue with their costs. I have worked in healthcare for 25 years and it is the worst it has ever been. Obama care was the one of the biggest jokes and health insurance is nothing but organized crime. It's time the insurance companies get investigated and pay the price, but sadly the consumer will be the one to pick up the costs unless RFK can regulate this within reasonable pricing. US healthcare needs to be overhauled.
This post was edited on 2/21/25 at 9:26 am
Posted on 2/21/25 at 9:25 am to TDTOM
quote:
UNH is different than other insurers in that they actually employ physicians.
Almost all the big payers employ doctors. Most of the Blues, Baylor Scott & White, and many more. Hell, most of them have clinics and hospitals now.
And they are all doing the same thing.
Posted on 2/21/25 at 9:30 am to TDTOM
quote:
UNH is different than other insurers in that they actually employ physicians
Every private health insurance company employs physicians. Many are there to take take of prior authorizations for testing. It is the biggest joke, they have pediatricians telling some of the cardiologist i work with that angiograms are not warranted at time when it is 100% necessary. I have seen and heard it first hand and insurance companies should be held accountable for sentinel events that occur when they deny testing that they deem unnecessary, should have been done to save the patient.
This post was edited on 2/21/25 at 10:18 am
Posted on 2/21/25 at 9:32 am to TDTOM
quote:
I heard on CNBC
quote:
bullshite
Checks out
Posted on 2/21/25 at 9:35 am to The Egg
Here comes the proggies and Dems to white knight for healthcare insurers.
Posted on 2/21/25 at 9:36 am to The Egg
more here LINK
quote:
The Wall Street Journal reported a series of articles last year on how Medicare paid UnitedHealth billions of dollars for questionable diagnoses. In December, the outlet analyzed Medicare records and found that patients seen by UnitedHealth-employed doctors saw a sharp rise in lucrative diagnoses after switching to the company’s Medicare Advantage plans.
Multiple doctors told the Journal that they were trained to document revenue-generating diagnoses. They also said that the company used software to suggest conditions and rewarded doctors with bonuses for considering them.
Posted on 2/21/25 at 10:06 am to The Egg
I despise health insurance companies, but this is complicated. Medicare requires doctors to add diagnosis codes to the patients record on a yearly basis to accurately identify the complexity of the patient to account for how much money a doctor gets for their “panel” of patients. The question that has to be asked is whether the doctors/insurance companies were actually upcoding or were they just playing the game that Medicare created.
Posted on 2/21/25 at 10:08 am to The Egg
This is how you attack these companies, not by murdering their CEOs. All that murder did was promote Luigi. It did nothing to affect any changes.
Posted on 2/21/25 at 10:09 am to The Egg
CEOs need to be ruined financially and the folks pushing the buttons need to be prosecuted to the fullest extent of the law...
We have been on corruption auto-pilot for way too long...
We have been on corruption auto-pilot for way too long...
Posted on 2/21/25 at 10:11 am to Sweet Pickles
I agree. There seems to be a misconception of what is happening here.
I work adjacent to this space and am pretty familiar with how it works.
Essentially, cms pays Medicare advantage plans based on how sick their patients are (how many chronic conditions etc) and rates them on their ability to care for those patients to determine how much they should be paid. Many patients never go to the doctor or went just before a time period and therefore have diagnoses that are not accounted for in claims.
Plans can send nurses to Dr offices “chart chasing” to find icd codes that didn’t make it onto claims or they can send nurses to those members houses to determine whether they are sicker then what the claims suggest.
There is a lot of opportunity for nefariousness.
I work adjacent to this space and am pretty familiar with how it works.
Essentially, cms pays Medicare advantage plans based on how sick their patients are (how many chronic conditions etc) and rates them on their ability to care for those patients to determine how much they should be paid. Many patients never go to the doctor or went just before a time period and therefore have diagnoses that are not accounted for in claims.
Plans can send nurses to Dr offices “chart chasing” to find icd codes that didn’t make it onto claims or they can send nurses to those members houses to determine whether they are sicker then what the claims suggest.
There is a lot of opportunity for nefariousness.
Posted on 2/21/25 at 10:17 am to The Egg
I heard about this years ago - I thought the companies were coaching up the healthcare providers on adding codes. But, they're adding them on their own? That would seem like a good way to bring the hammer from the feds.
Posted on 2/21/25 at 10:24 am to The Egg
All involved in this sceme need to go to prison
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