Medicare Advantage has been viewed by many as the public-private salvation of the troubled federal health care program for older Americans. But now a whistle-blower, a former well-placed official at UnitedHealth Group, says the big insurance companies have been systematically bilking Medicare Advantage for years.
From the New York Times:
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.”
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