Nation's Beloved Health Insurance Companies Might Be Scamming Medicare? That Can't Be Right!
And therefore scamming us.
There are few institutions more adored in the United States of America than private health insurance companies. People love the choices they provide, which definitely exist, even if I have no idea what they are and no one can explain them to me.
And yet, these companies keep doing practically everything they can to deplete the seemingly bottomless trough of trust that Americans have in them.
For instance! On Monday, the Wall Street Journal — the truism about their reporting being excellent while their op-ed board runs amok may still hold! — ran an exposé about the tendency of these companies to claim Medicare Advantage customers suffer from a variety of ailments for which they never receive any treatment, so Medicare will give them more money.
The way it works is that these companies offer to send a doctor to the home of someone subscribed to Medicare Advantage (a program in which private insurers contract with Medicare to provide health insurance to seniors and the disabled), and then the doctor puts it in their file that they have certain health issues. In most cases, the patient and their actual doctor were entirely aware of this.
Medicare pays these companies a base rate of $3735 per person they cover, but this number increases with each additional diagnosis. For instance, a diagnosis of diabetic cataracts will net an additional $2,863, while seizures will bring in $2,806. From 2018 to 2021, the article alleges, these companies bilked Medicare out of $50 billion this way.
Via Wall Street Journal:
The Journal reviewed the Medicare data under a research agreement with the federal government. The data doesn’t include patients’ names, but covers details of doctor visits, hospital stays, prescriptions and other care. The Journal identified the patients named in this article through their doctors.
Some diagnoses claimed by insurers were demonstrably false, the Journal found, because the conditions already had been cured. More than 66,000 Medicare Advantage patients were diagnosed with diabetic cataracts even though they already had gotten cataract surgery, which replaces the damaged lens of an eye with a plastic insert.
“It’s anatomically impossible,” said Dr. Hogan Knox, an eye specialist at University of Alabama at Birmingham. “Once a lens is removed, the cataract never comes back.”
Whoops! You’d think that would be something that their very thorough doctors would pick up on, but apparently not. Oddly enough, 36,000 of those the insurers said were suffering from diabetic cataracts were not being treated for diabetes, either. Is that dangerous? It seems dangerous!
This has also happened with HIV.
About 18,000 Medicare Advantage recipients had insurer-driven diagnoses of HIV, the virus that causes AIDS, but weren’t receiving treatment for the virus from doctors, between 2018 and 2021, the data showed. Each HIV diagnosis generates about $3,000 a year in added payments to insurers.
Everyone with HIV should be on antiretroviral drugs, the only effective treatment, and nearly all Medicare patients whose doctors diagnosed the virus took the drugs. Less than 17% of patients with insurer-driven HIV diagnoses were on them, the Journal found.
Sure, it’s possible that these people just had bad judgment and thought, “You know, I’m just gonna see how this goes — who needs retrovirals?” … but it’s not likely.
Naturally, insurers like UnitedHealth and Humana denied that any of this is happening. They say that their doctors are simply more thorough than regular doctors and catch health problems even before they become an issue. This also does not seem very likely.
If it is true, however, these companies are stealing from us, and not just in the usual way where they take our money and then pay people to figure out how to keep us from getting anything in return for it. When they diagnose people with health conditions they don’t have in order to get more money from the US government, they are stealing our tax money that we could hypothetically use to actually help people (or bomb them, one of the two).
Andrew Witty, the CEO of UnitedHealth, makes $23 million a year. As understandable as it is that he may not feel this is enough for him to live (in Elon Musk’s future Mars colony) on, that does not justify stealing from hard-working Americans (in a slightly different way than he usually does).
There are contractors whose job it is to audit these payments and get our money back if it is determined that these companies scammed us — so hopefully they can get some of it back if that is the case. And perhaps someday, somehow we can figure out a way to provide our citizens with healthcare in a less stupid way.
PREVIOUSLY:
>> And perhaps someday, somehow we can figure out a way to provide our citizens with healthcare in a less stupid way. <<
What if, and I'm just spitballing here, what if when a person went to the doctor, instead of sending paperwork proof to the insurance company, getting money back to cover the doctoring costs, and then the insurance e company sending a new, larger bill to the government to cover the doctoring, plus the insurance company overhead, plus insurance company profits, plus insurance company fraud....
What if the doctor sent the doctoring costs paperwork to the government and the government paid just that much and no more?
This seems so crazy it just might work.
As far as I'm concerned seeking to make a profit off of the pain and suffering of other human beings is a crime against humanity.