[HN Gopher] DOJ Investigates Medicare Billing Practices at Unite...
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       DOJ Investigates Medicare Billing Practices at UnitedHealth
        
       Author : Jimmc414
       Score  : 14 points
       Date   : 2025-02-21 21:50 UTC (1 hours ago)
        
 (HTM) web link (www.wsj.com)
 (TXT) w3m dump (www.wsj.com)
        
       | redeux wrote:
       | Actual fraud coming from a private company taking advantage of
       | the US Government, which is how almost all fraud happens - not
       | from the "deep state"
        
       | Jimmc414 wrote:
       | https://archive.is/mGLAY
        
       | Jimmc414 wrote:
       | UnitedHealth allegedly received $8.7 billion in extra federal
       | payments in 2021 just for diagnoses that were never actually
       | treated.
       | 
       | Through their "HouseCalls" unit, each nurse visit triggered an
       | average of $2,735 in additional government payments; just for
       | documenting conditions, not treating them.
       | 
       | UnitedHealth trained doctors to document revenue-generating
       | diagnoses
       | 
       | Used software to suggest profitable diagnoses
       | 
       | Paid bonuses to providers who followed these suggestions
       | 
       | Added diagnoses without lab tests or confirmation
       | 
       | The same patients suddenly had many more lucrative diagnoses
       | after joining UnitedHealth's Medicare Advantage plans versus
       | before.
       | 
       | When confronted, rather than addressing the specific allegations
       | about billing practices, UnitedHealth called the WSJs reporting
       | "outrageous and false" and claimed it was part of a "campaign
       | against Medicare Advantage."
       | 
       | The company seemingly built entire systems in a deliberate,
       | systematic effort to maximize government payments rather than
       | isolated incidents or honest mistakes.
        
       | impish9208 wrote:
       | Earlier: https://news.ycombinator.com/item?id=43127111
        
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       (page generated 2025-02-21 23:01 UTC)