The Wall Street Journal reported this week on how insurers like UnitedHealth maximized Medicare Advantage plan reimbursement revenue from 2016 through 2023.
A team followed up on reports from agencies like the U.S. Government Accountability Office and lawmakers like Sen. Elizabeth Warren, D-Mass. They added their own colorful anecdotes to flesh out allegations that insurers get billions of dollars in extra payments by making patients look sicker than they are.
In an article published Tuesday, the team presented accounts of doctors classifying patients who were in good shape as morbidly obese and classifying a patient who had slightly slow, aspirin-affected blood clotting as having qualitative platelet disorder, a rare blood clotting disorder.
UnitedHealth representatives were not immediately available to comment on the article.
Critics of Medicare Advantage plans contend that some insurers manipulate a Medicare Advantage program mechanism that provides higher payments for higher-risk enrollees by making aggressive, sometimes dishonest efforts to indicate that ordinary enrollees are seriously ill.
Earlier in the year, the Wall Street Journal published accounts of insurers getting "$50 billion from Medicare for disease no doctors treated," such as cases of "diabetic cataracts" in patients without diabetes, and "one-hour nurse visits that let insurers collect $15 billion from Medicare," or efforts to use home visits by nurses to create comprehensive lists of enrollees' health problems.
