4 ms·

*killed, not kill. This happened in 2014 and came to light as a part of a current multibillion dollar DoJ lawsuit against United Healthcare.

by chomp 2y ago

cool_dude85 2y ago
Since you seem to be clued in on this - what is United's defense here other than to muddy the waters? It seems from the article that they must sign an affidavit, or otherwise formally state, that the codes are valid to their best knowledge. But they do all these reviews that show some of the codes aren't valid, but they still bill for them. Seems pretty cut and dried.
- nradov 2y ago
  I won't say anything specific about UnitedHealthcare or take a position on their actions but will comment generally about Medicare Advantage plans. The standard defense is that many of the diagnosis codes are highly subjective and depend on clinician judgment more than objective lab tests. Different doctors might reach different conclusions but that's normal in medicine and doesn't necessarily indicate fraud or malpractice. Health plans will also claim that adding formal diagnosis codes for all of a patient's conditions to their chart helps to get them the best care.
  - firesteelrain 2y ago
    Getting them the care is key. It’s not clear the care was provided at all.
- roenxi 2y ago
  Making some guesses, but probably by spinning the plan the way it was presented in the first two paragraphs of the article. There is a system for when one party wrongs another - the wronged party takes them to court and justifies why there should be redress. The idea at the start of the article seems to be that the government seems to want to override that with some other process the seems to involve people dobbing each other in or employees looking for opportunities to send their employers money to, effectively, the tax office. I'd be furious if someone tried to involve me in such a system. I don't want to be dealing with people who are looking for opportunities to get me in trouble or vice versa.
  - ruthmarx 2y ago
    > I'd be furious if someone tried to involve me in such a system. I don't want to be dealing with people who are looking for opportunities to get me in trouble or vice versa. If the things people are trying to catch people for are immoral and massively harmful, then everyone moral should willing want to participate in such a system.
seaourfreed 2y ago
The US Gov used to put people in prison for these things. Now it is a financial law suit slap on the wrist.
- briffle 2y ago
  They would still put you in jail. But when you steal billions, you get to pay a $200M fine, with no admission of wrongdoing….
  - dredmorbius 2y ago
    Prosecutors, as with all predator classes, choose their targets carefully so as not to both expend unrewarding effort and avoid self-injury. Unfortunately, this means often foregoing large and egregious targets, such as the organised criminal syndicate known as United Healthcare, in favour of far smaller, and more tractable, targets. This has always been the case, and is hardly limited to the United States. Finding ways to remedy this fundamental systemic dysfunction would be greatly appreciated. (The observation in my first 'graph isn't a sneer or slight at prosecutors, though some of those might also be deserved. It's a recognition of the nature of the activity.)
dredmorbius 2y ago
Right. The headline was edited to fit HN length limits with the unfortunate effect of making a decade-old action appear to be current. I'd suggest dropping "Advantage" which reduces specificity but doesn't mislead to the same extent. My own practice is to note headline edits in a submission comment, whether for length, clarity, removing clickbait / outrage, etc. And the fact that the past nature of the event is immediately clear in the first 'graph of TFA strongly encourages the act of R'ing TFA, rather than reacting blindly to headlines. (I've emailed mods suggesting an improved title of: "Feds Killed Plan to Curb Medicare Overbilling After Industry Opposition in 2014".)
- epmaybe 2y ago
  Advantage is relevant. Medicare advantage is a specific type of plan that isn’t quite Medicare that insurance companies offer. And it’s at the center of that case.
  - dredmorbius 2y ago
    The question isn't what is relevant, the question is comparative relevance. "Medicare plan" might be another option, though my suggestion to add the year already comes up hard against HN's 80-char limit. Wordsmithing titles is in fact both hard and a matter of compromises. HN's guidance is to use the original title, except where that's misleading or clickbait, and as an alternative to shorten that, or to substitute alternate text from either a subhead / alternate headline, or the article itself: <https://news.ycombinator.com/item?id=29899854 https://news.ycombinator.com/item?id=29899854> If you care to suggest something that is accurate, covers the relevant elements, and fits inside 80 characters, you're welcome to do so. It makes the mods' decision and action far easier, and is why I'd made a specific recommendation myself. I'm not wedded to that, but it is my good faith best-effort attempt. I'm happy to consider better. I've scoured the article a few times with limited success myself. Though "DoJ alleges United Healthcare cheated Medicare out of more than $2 billion" (from "Justice Department alleges the giant health insurer cheated Medicare out of more than $2 billion") might also work, and makes the titled action current. 74 characters. (I've submitted that as an alternate to HN's overworked mods as well.)
newsclues 2y ago
Oh so the Hope for America was fake?
dang 2y ago
I've edited the title to make that clearer. Thanks!

*killed, not kill. This happened in 2014 and came to light as a part of a current multibillion dollar DoJ lawsuit against United Healthcare.

by chomp 2y ago

*killed, not kill. This happened in 2014 and came to light as a part of a current multibillion dollar DoJ lawsuit against United Healthcare.

cool_dude85 2y ago

Since you seem to be clued in on this - what is United's defense here other than to muddy the waters? It seems from the article that they must sign an affidavit, or otherwise formally state, that the codes are valid to their best knowledge. But they do all these reviews that show some of the codes aren't valid, but they still bill for them. Seems pretty cut and dried.

nradov 2y ago
I won't say anything specific about UnitedHealthcare or take a position on their actions but will comment generally about Medicare Advantage plans. The standard defense is that many of the diagnosis codes are highly subjective and depend on clinician judgment more than objective lab tests. Different doctors might reach different conclusions but that's normal in medicine and doesn't necessarily indicate fraud or malpractice. Health plans will also claim that adding formal diagnosis codes for all of a patient's conditions to their chart helps to get them the best care.
- firesteelrain 2y ago
  Getting them the care is key. It’s not clear the care was provided at all.
roenxi 2y ago
Making some guesses, but probably by spinning the plan the way it was presented in the first two paragraphs of the article. There is a system for when one party wrongs another - the wronged party takes them to court and justifies why there should be redress. The idea at the start of the article seems to be that the government seems to want to override that with some other process the seems to involve people dobbing each other in or employees looking for opportunities to send their employers money to, effectively, the tax office. I'd be furious if someone tried to involve me in such a system. I don't want to be dealing with people who are looking for opportunities to get me in trouble or vice versa.
- ruthmarx 2y ago
  > I'd be furious if someone tried to involve me in such a system. I don't want to be dealing with people who are looking for opportunities to get me in trouble or vice versa. If the things people are trying to catch people for are immoral and massively harmful, then everyone moral should willing want to participate in such a system.

seaourfreed 2y ago

The US Gov used to put people in prison for these things. Now it is a financial law suit slap on the wrist.

briffle 2y ago
They would still put you in jail. But when you steal billions, you get to pay a $200M fine, with no admission of wrongdoing….
- dredmorbius 2y ago
  Prosecutors, as with all predator classes, choose their targets carefully so as not to both expend unrewarding effort and avoid self-injury. Unfortunately, this means often foregoing large and egregious targets, such as the organised criminal syndicate known as United Healthcare, in favour of far smaller, and more tractable, targets. This has always been the case, and is hardly limited to the United States. Finding ways to remedy this fundamental systemic dysfunction would be greatly appreciated. (The observation in my first 'graph isn't a sneer or slight at prosecutors, though some of those might also be deserved. It's a recognition of the nature of the activity.)

dredmorbius 2y ago

Right. The headline was edited to fit HN length limits with the unfortunate effect of making a decade-old action appear to be current. I'd suggest dropping "Advantage" which reduces specificity but doesn't mislead to the same extent. My own practice is to note headline edits in a submission comment, whether for length, clarity, removing clickbait / outrage, etc. And the fact that the past nature of the event is immediately clear in the first 'graph of TFA strongly encourages the act of R'ing TFA, rather than reacting blindly to headlines. (I've emailed mods suggesting an improved title of: "Feds Killed Plan to Curb Medicare Overbilling After Industry Opposition in 2014".)

epmaybe 2y ago
Advantage is relevant. Medicare advantage is a specific type of plan that isn’t quite Medicare that insurance companies offer. And it’s at the center of that case.
- dredmorbius 2y ago
  The question isn't what is relevant, the question is comparative relevance. "Medicare plan" might be another option, though my suggestion to add the year already comes up hard against HN's 80-char limit. Wordsmithing titles is in fact both hard and a matter of compromises. HN's guidance is to use the original title, except where that's misleading or clickbait, and as an alternative to shorten that, or to substitute alternate text from either a subhead / alternate headline, or the article itself: <https://news.ycombinator.com/item?id=29899854 https://news.ycombinator.com/item?id=29899854> If you care to suggest something that is accurate, covers the relevant elements, and fits inside 80 characters, you're welcome to do so. It makes the mods' decision and action far easier, and is why I'd made a specific recommendation myself. I'm not wedded to that, but it is my good faith best-effort attempt. I'm happy to consider better. I've scoured the article a few times with limited success myself. Though "DoJ alleges United Healthcare cheated Medicare out of more than $2 billion" (from "Justice Department alleges the giant health insurer cheated Medicare out of more than $2 billion") might also work, and makes the titled action current. 74 characters. (I've submitted that as an alternate to HN's overworked mods as well.)

newsclues 2y ago

Oh so the Hope for America was fake?

dang 2y ago

I've edited the title to make that clearer. Thanks!