A former high-ranking employee of UnitedHealth Group Inc., a healthcare company based out of Minnesota, has gone public with a whistleblowing case against his former employer, alleging that they purposefully and knowingly gamed the country’s chaotic healthcare system in order to get more money from the federal government.
The situation is an incredibly tangled web of different organizations, government agencies and winding policy, but the crux of the matter is as such:
- Healthcare insurance providers, such as UnitedHealth Group, are given money through the federal government’s Centers for Medicare and Medicaid Services (C.M.S.)
- Insurance providers use this money to pay doctors, who bill the insurance companies for services rendered to their patients
- Insurers get paid more money by the government if they enroll people with worse health complications, an incentive to prevent sick people from being systematically denied coverage
- This system is known as “Medicare Advantage,” and was implemented by the federal government in the hopes that it would result in better care at a lower cost and help cover a $13 trillion funding gap for Medicare.
- However the whistleblower, Benjamin Poehling, alleges that insurance companies have been intentionally misreporting patient charts as a way to milk more money from the government, which is going directly into pockets and not helping patients in any way.
The lawsuit, filed under the False Claims Act, alleges that UnitedHealth Group would take patients with health complications such as diabetes and then explore every possible other condition they could have suffered as a result in order to boost that patient’s profitability to the company.
At the same time, the insurance provider would ignore possible complications such as high blood pressure, as these diagnoses did not carry a profitable incentive from the C.M.S. In short, the lawsuit alleges that UnitedHealth Group treated its patients as nothing more than a part of their profit margin, rather than treating them as human beings in need of care.
One particular email that was obtained in the lawsuit, as was reported by the New York Times, shows a disgusting, almost salesman-like attitude coming from a chief financial officer within UnitedHealth Group.
“You mentioned vasculatory disease opportunities, screening opportunities, etc., with huge $ opportunities,” the chief financial officer of Poehling’s division wrote. “Let’s turn on the gas!”
Patients are people, not profit
This lawsuit is, unfortunately, not the only incident involving insurance companies allegedly defrauding the federal government to line their pockets with taxpayer money at the expense of patients. In fact, estimates about the total amount of overcharge within the healthcare industry hover at around $10 billion annually, and the Government Accountability Office reported that C.M.S. had overpaid insurers by over $14 billion in 2013.
The Department of Justice is currently investigating four other Medicare Advantage insurers: Aetna, Cigna’s Bravo Health, Humana and Health Net. The department said in March it would join another whistleblower suit filed by a former data manager who alleged the same practices going on.
If these allegations turn out to be true, it is simply appalling behavior no matter how it is framed. Patients should be treated as human beings in need of proper care and support, not potential cash cows to be used unknowingly in an effort to defraud the federal government out of money that it literally cannot afford to overspend on.
If you feel as though you or a loved one were improperly treated by an insurance provider, whether you were overcharged or put through tests that seemed unnecessary or any other suspicious behavior, call the law office of Altman & Altman LLP today. We will provide free consultations to go over the details of your claim.
Call 617-492-3000 or toll-free at 800-481-6199 today. We are available