UnitedHealth Group Whistleblower Interview in NY Times

[Brian Anderson]

Yesterday’s NY Times featured an article interviewing former finance director at UnitedHealth Group Benjamin Poehling, who contends UHG systematically bilked Medicare Advantage for years that a huge whistleblower lawsuit that the Justice Department has joined. Remember of course UHG is the largest underwriter of MA plans with 4.6 million enrollees/23.7% of the market.

From the article:

In the first interview since his allegations were made public, the whistle-blower, Benjamin Poehling of Bloomington, Minn., described in detail how his company and others like it — in his view — gamed the system: Finance directors like him monitored projects that UnitedHealth had designed to make patients look sicker than they were, by scouring patients’ health records electronically and finding ways to goose the diagnosis codes.

The sicker the patient, the more UnitedHealth was paid by Medicare Advantage — and the bigger the bonuses people earned, including Mr. Poehling…

“They’ve set up a perfect scheme here,” Mr. Poehling said in an interview. “It was rigged so there was no way they could lose.”

A spokesman for UnitedHealth, Matthew A. Burns, said the company rejected Mr. Poehling’s allegations and would contest them vigorously.

Much more in the full article linked here:

https://www.nytimes.com/2017/05/15/business/dealbook/a-whistle-blower-tells-of-health-insurers-bilking-medicare.html?emc=edit_tnt_20170515&nlid=41277873&tntemail0=y&_r=0

 

[Fisher]

**The sicker the patient, the more UnitedHealth was paid by Medicare Advantage**

That doesn't make sense. MAPD cos. are paid by Medicare Advantage? Silly reporter.

 

[Todd King]

Yesterday’s NY Times featured an article interviewing former finance director at UnitedHealth Group Benjamin Poehling, who contends UHG systematically bilked Medicare Advantage for years that a huge whistleblower lawsuit that the Justice Department has joined. Remember of course UHG is the largest underwriter of MA plans with 4.6 million enrollees/23.7% of the market.

From the article:

In the first interview since his allegations were made public, the whistle-blower, Benjamin Poehling of Bloomington, Minn., described in detail how his company and others like it — in his view — gamed the system: Finance directors like him monitored projects that UnitedHealth had designed to make patients look sicker than they were, by scouring patients’ health records electronically and finding ways to goose the diagnosis codes.

The sicker the patient, the more UnitedHealth was paid by Medicare Advantage — and the bigger the bonuses people earned, including Mr. Poehling…

“They’ve set up a perfect scheme here,” Mr. Poehling said in an interview. “It was rigged so there was no way they could lose.”

A spokesman for UnitedHealth, Matthew A. Burns, said the company rejected Mr. Poehling’s allegations and would contest them vigorously.

Much more in the full article linked here:

https://www.nytimes.com/2017/05/15/business/dealbook/a-whistle-blower-tells-of-health-insurers-bilking-medicare.html?emc=edit_tnt_20170515&nlid=41277873&tntemail0=y&_r=0

Isn't this the issue that is being referred to recently that Trump has put the feds on this case? I think it was pretty much being ignored until recently.

 

[Justin Bilyj]

I read about this yesterday. Is there a case here? Not really. The FEDS instructed the companies to come up with a program that manages the health of Medicare beneficiaries. They construct a system to classify risk. Now some guy (probably a SJW) has an issue with it and tries to draw attention by acting like a whistleblower. Even the FEDS decided not to act on similar cases before this, but it's because of a statute of limitations they decided to act on this particular case to build leverage against UHC.

Now was the executive crass in his communications? Yes, but does that mean they broke the law? No. The whistle-blower's argument was that the insurance company opted for a diabetes classification for complications as opposed to high blood pressure because it pays more. I don't think any doctor can for sure say that complications were due to high blood pressure and not diabetes - this isn't 2D analysis here.

Personally, scrap all MA plans, go towards all Medigap and give out a subsidy based on income if need be. Scrap the networks (maybe Medigap select as opposed to MA?) and do away with the annual changes crap.

End rant...

 

[Newby]

How come on a normal day everyone including insurance agents call these plans AARP not United Healthcare? But as soon as there is bad publicity there is no mention of AARP anywhere?

Must be a strong PR person at AARP.

 

[Brian Anderson]

How come on a normal day everyone including insurance agents call these plans AARP not United Healthcare? But as soon as there is bad publicity there is no mention of AARP anywhere?

Must be a strong PR person at AARP.

Funny you mention this. Ron Iverson over at NAMSMAP had this comment in his newsletter about that very topic:

"It is no small fact that most of UHG’s production comes from AARP—for which AARP receives over a $100 million in income from UHG each year. I don’t think you’ll see anything about all of this commotion in any AARP publications."

 

[hlb96]

Funny you mention this. Ron Iverson over at NAMSMAP had this comment in his newsletter about that very topic:

"It is no small fact that most of UHG’s production comes from AARP—for which AARP receives over a $100 million in income from UHG each year. I don’t think you’ll see anything about all of this commotion in any AARP publications."

In Louisiana the MAPD plans are branded UHC not AARP. Only PDP and Med Supp are branded AARP. So Im sure thats why you won't see AARP listed in this case.

 

[yorkriver1]

One of the whistleblower's complaints was that the records used for justifying higher Medicare payment levels were electronically culled from medical claim records instead of determined by home visits or phone interviews with the insured's. If I recall the details, the rules were that the higher level payments were supposed to be based on UHC case evaluators making live contact with the Medicare clients.
It's painful to read media stories about healthcare, Medicare, Medicaid. I know half the time I see Medicare or Medicaid, the writer has them mixed up.

 

[wehotex]

I read about this yesterday. Is there a case here? Not really. The FEDS instructed the companies to come up with a program that manages the health of Medicare beneficiaries. They construct a system to classify risk. Now some guy (probably a SJW) has an issue with it and tries to draw attention by acting like a whistleblower. Even the FEDS decided not to act on similar cases before this, but it's because of a statute of limitations they decided to act on this particular case to build leverage against UHC.

Now was the executive crass in his communications? Yes, but does that mean they broke the law? No. The whistle-blower's argument was that the insurance company opted for a diabetes classification for complications as opposed to high blood pressure because it pays more. I don't think any doctor can for sure say that complications were due to high blood pressure and not diabetes - this isn't 2D analysis here.

Personally, scrap all MA plans, go towards all Medigap and give out a subsidy based on income if need be. Scrap the networks (maybe Medigap select as opposed to MA?) and do away with the annual changes crap.

End rant...

What's an "SJW"?

----------

Funny you mention this. Ron Iverson over at NAMSMAP had this comment in his newsletter about that very topic:

"It is no small fact that most of UHG’s production comes from AARP—for which AARP receives over a $100 million in income from UHG each year. I don’t think you’ll see anything about all of this commotion in any AARP publications."

AARP is stupid to settle on such chump change. They could swindle UHC for so much more.

 

[yogooglethis]

How come on a normal day everyone including insurance agents call these plans AARP not United Healthcare? But as soon as there is bad publicity there is no mention of AARP anywhere?

Must be a strong PR person at AARP.

Why should they in this case? AARP is a separate organization that has nothing to to do with UHC medicare health plan operations.In fact I would guesstimate than more than 70% of UHC MA plans do not even have the AARP name attached to it.Also agents who insinuate they represent AARP when selling UHC MA plans can be terminated so UHC definitely doesn't condone that.