Great column. DOJ should investigate and and penalize United healthcare for their corrupt up coding of patient’s diagnoses who receive Medicare Advantage.
Eliminate Medicare advantage, and have everyone eligible be on traditional Medicare. We could improve the care for traditional Medicare and decrease the costs by utilizing Medicare funds and eliminating the corruption and cheating of Medicare advantage by for
profit insurance companies who are more interested in their shareholders than in their patients.
United has paid many times over the years for different violations. Unless there is the will to stand up to the business itself, these fines are no genuine disincentive when you make billions in profit each quarter. Cases like this take years and in the meantime, UHC runs amok.
Unfortunately the government permitted loose regulation of allowing Advantage to bill higher fees for more complicated diagnoses. This turned into pressure upon clinicians to upcode visits, incentivizing with bonuses. The government foots the bill to the tune of billions overpayments. For example, if a person goes in for a simple urinary infection, and if that person is diabetic, the clinician may ask if blood sugar is under control and if patient answers sugar testing has been in normal range, then clinician will bill for the bladder infection and add a more complicated visit diagnosis of Diabetes with significantly higher reimbursement, even though there is no evidence of abnormal effect on patient’s diabetes.
Insurers at first refused to participate in Medicare age groups unless rules were relaxed and they received extra monies yearly for all enrollees. Advantage is the highest profits for medical insurers. The attraction for the government was that Advantage as a HMO type program would provide better care at lower costs. This turns out not to be the case. In fact I do not consider Advantage a Medicare program, it is a private insurance program looking to bottom line profits at the expense of taxpayers and detrimental to the health of many individuals. The detriment is from denied needed care and delayed approval of needed care.
Medical care should not be a profit driven system that rewards stock owners and corporations by preying on the ill. This is immoral.
I read that Medicare Advantage was originally trying to select the healthiest clients. The idea of paying for ailments was an attempt to persuade the MA companies to accept sicker clients.
Then the companies got the idea of adding diagnoses to healthy clients to collect the extra $.
Even if no doctor ever made that diagnosis. FRAUD.
MA attracts by promising no monthly premiums and adds small benefits for hearing, vision, dental. Traditional Medicare should be offering benefits in the same categories. Traditional Medicare should also drop the Medigap feature and incorporate it into Part B without private insurance participation.
One major hurdle is once a person goes to MA and with time and in most states, it is very difficult to go to Traditional Medicare with Part B 20% Medigap by private insurers now able to underwrite and charge people more for certain medical illnesses. This is not well enough explained upfront.
So the numbers indicate MA taking in close to 15% fees for profit as opposed to Traditional running costs in 3% range, without MA showing benefit of improved outcomes. MA will break the Medicare payment system with its ongoing fraud if not brought under control. And the supposed added benefit of the nursing home care program needs reexamination.
People must remember that both the Social Security system and Medicare system are funded by lifelong taxes we paid. It is not a government giveaway program to us but it is to the private insurers.
Dump Medicare Advantage Plan if you have it! They have prior authorization on most drugs and make you wait even though you need the meds now. I almost changed my Medicare to an advantage plan and even signed up it sounded so good, but after research I found that you can only get doctors and dentist s in their network and they weren’t in an area close to me. I read horror stories from patients and read reports that extolled what was truly awful care. I canceled my advantage plan and stuck with my original Medicare plan. Never had any complaints about it. Never was refused care or had a prior authorization for anything. I am very happy with original mediate!
It’s about time. People have been dying because of the “health” insurance industry for generations. Back in the 70s I worked in a university based safety net hospital. It was never pretty. Poverty is ugly even when you are healthy. No one wants to worry about an illness making them homeless because they can’t work. They want to feel healthy again. Imagine having a serious chronic illness without access to food and heating/air conditioning. Yet that has been the reality for as long as I can remember. No excuses for health “insurance” industry. Other countries do very very well without them.
Those who wish to strike a blow against United Health should donate to www.utahcares.vote which will bring a single payer ballot initiative to the voters in 2026. Let’s eliminate the health insurance business model.
Great column. DOJ should investigate and and penalize United healthcare for their corrupt up coding of patient’s diagnoses who receive Medicare Advantage.
Eliminate Medicare advantage, and have everyone eligible be on traditional Medicare. We could improve the care for traditional Medicare and decrease the costs by utilizing Medicare funds and eliminating the corruption and cheating of Medicare advantage by for
profit insurance companies who are more interested in their shareholders than in their patients.
United has paid many times over the years for different violations. Unless there is the will to stand up to the business itself, these fines are no genuine disincentive when you make billions in profit each quarter. Cases like this take years and in the meantime, UHC runs amok.
https://violationtracker.goodjobsfirst.org/?company=United+Healthcare&order=pen_year&sort=
Unfortunately the government permitted loose regulation of allowing Advantage to bill higher fees for more complicated diagnoses. This turned into pressure upon clinicians to upcode visits, incentivizing with bonuses. The government foots the bill to the tune of billions overpayments. For example, if a person goes in for a simple urinary infection, and if that person is diabetic, the clinician may ask if blood sugar is under control and if patient answers sugar testing has been in normal range, then clinician will bill for the bladder infection and add a more complicated visit diagnosis of Diabetes with significantly higher reimbursement, even though there is no evidence of abnormal effect on patient’s diabetes.
Insurers at first refused to participate in Medicare age groups unless rules were relaxed and they received extra monies yearly for all enrollees. Advantage is the highest profits for medical insurers. The attraction for the government was that Advantage as a HMO type program would provide better care at lower costs. This turns out not to be the case. In fact I do not consider Advantage a Medicare program, it is a private insurance program looking to bottom line profits at the expense of taxpayers and detrimental to the health of many individuals. The detriment is from denied needed care and delayed approval of needed care.
Medical care should not be a profit driven system that rewards stock owners and corporations by preying on the ill. This is immoral.
I read that Medicare Advantage was originally trying to select the healthiest clients. The idea of paying for ailments was an attempt to persuade the MA companies to accept sicker clients.
Then the companies got the idea of adding diagnoses to healthy clients to collect the extra $.
Even if no doctor ever made that diagnosis. FRAUD.
You are correct about this aspect of the history.
MA attracts by promising no monthly premiums and adds small benefits for hearing, vision, dental. Traditional Medicare should be offering benefits in the same categories. Traditional Medicare should also drop the Medigap feature and incorporate it into Part B without private insurance participation.
One major hurdle is once a person goes to MA and with time and in most states, it is very difficult to go to Traditional Medicare with Part B 20% Medigap by private insurers now able to underwrite and charge people more for certain medical illnesses. This is not well enough explained upfront.
So the numbers indicate MA taking in close to 15% fees for profit as opposed to Traditional running costs in 3% range, without MA showing benefit of improved outcomes. MA will break the Medicare payment system with its ongoing fraud if not brought under control. And the supposed added benefit of the nursing home care program needs reexamination.
People must remember that both the Social Security system and Medicare system are funded by lifelong taxes we paid. It is not a government giveaway program to us but it is to the private insurers.
Dump Medicare Advantage Plan if you have it! They have prior authorization on most drugs and make you wait even though you need the meds now. I almost changed my Medicare to an advantage plan and even signed up it sounded so good, but after research I found that you can only get doctors and dentist s in their network and they weren’t in an area close to me. I read horror stories from patients and read reports that extolled what was truly awful care. I canceled my advantage plan and stuck with my original Medicare plan. Never had any complaints about it. Never was refused care or had a prior authorization for anything. I am very happy with original mediate!
It’s about time. People have been dying because of the “health” insurance industry for generations. Back in the 70s I worked in a university based safety net hospital. It was never pretty. Poverty is ugly even when you are healthy. No one wants to worry about an illness making them homeless because they can’t work. They want to feel healthy again. Imagine having a serious chronic illness without access to food and heating/air conditioning. Yet that has been the reality for as long as I can remember. No excuses for health “insurance” industry. Other countries do very very well without them.
Similar to building the Titanic (part c) ease the safety regulations in the name of competition/profit
Those who wish to strike a blow against United Health should donate to www.utahcares.vote which will bring a single payer ballot initiative to the voters in 2026. Let’s eliminate the health insurance business model.
Do you have any idea of how prevalent this type of fraud is in ALL of healthcare?
Please go to BluSky. Your insight and perspective is desperately needed.