4 ms·

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

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.

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.