The author recognizes UHG’s immense size and its expanding reach across various healthcare sectors, including insurance, managed care, and provider service. With this market dominance, UHG holds considerable leverage in negotiating rates and setting industry standards – requiring the post acute industry to work together to combat this power.
…On Oct. 24 a report from the US Department of Health and Human Services Office of the Inspector General was published that was just the latest evidence of how MA insurers pilfer tax dollars. OIG smelled something fishy in the fact that $7.5 billion had been paid out in 2023 for in-home health risk assessments, for which there had been no record on “any other 2022 service records.” Nor could OIG find “any other followup visits, procedures, tests, or supplies for these diagnoses in the MA encounter data[.]” UHG was only referred to enigmatically as “one top MA company;” however, it accounted for $3.5 billion of the questionable spending.
Typically, OIG reported that “CMS did not concur with our recommendation to restrict the use of” the questionable diagnoses, nor did it “concur or nonconcur with our recommendation for it to conduct audits to validate” the diagnoses….
…The OIG report came a week after a 54-page report from the U.S. Senate Permanent Subcommittee on Investigations documented what had been reported elsewhere, most thoroughly by STAT, and that is that insurers use algorithms to deny needed nursing home care, often through a UnitedHealth subsidiary, naviHealth.
Williams, B. (2024, November 4). It’s UnitedHealth Group’s world — we just live in it. McKnight’s Long-Term Care News. https://www.mcknights.com/blogs/guest-columns/its-unitedhealth-groups-world-we-just-live-in-it/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
