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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
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