3 ms·

Do you mean they should treat even if there is no diagnosis?

• blactuary 2y ago
  This has nothing to do with treatment at all. Quite the opposite in fact, it is merely a diagnosis, for the sole purpose of increasing the risk score. If the person had been treated for the condition there would be no need for the diagnosis. United Health Care and others have figured out that if you go to someone's home, dubiously diagnose them with a condition that Medicare has deemed expensive to cover, Medicare will send them more money to provide health insurance for that person, whether or not they actually have the condition or ever receive treatment for it. ETA to make it explicit with an exaggerated example: UHC gets say 10K/year from the govt to give you health insurance. Then UHC sends a nurse to your house who shines a flashlight in your ear and says "you have diabetes". Now UHC gets 15k/year from the govt to give you health insurance.
  • DataDive 2y ago
    right, but this has nothing to do with health care, nor nurses or patients It is simply that bureaucrats have passed regulations where they do not understand the repercussions Every domain that is bogged down by bureaucracy will have inefficiencies of various magnitudes.
    • frumper 2y ago
      This is fraud, not poor regulations. Insurance companies are misdiagnosing for the sole purpose of collecting more income. These people do not have these conditions. Many of these conditions are very rare and Medicare Advantage diagnosis rates are far above normal.
    • blactuary 2y ago
      This is not bureaucracy, it is fraud. They sold it as a way to save the government money, claiming that private insurers could do it more efficiently than Medicare. And then what actually happened was it costs more, because they fraudulently gamed the system.