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When health insurers create financial incentives to reduce hospitalizations, at what point does cost management cross the line into potentially criminal patient

When health insurers create financial incentives to reduce hospitalizations, at what point does cost management cross the line into potentially criminal patient endangerment, especially when the patients themselves have no knowledge that their emergency care decisions may be influenced by secret bonus structures designed to minimize expensive treatments?

nothercastle 1y ago
At what point are we willing to prosecute. That’s all that matters
- hedora 1y ago
  It looks like these programs were initiated under the CEO that was shot, and have continued under the new leadership. So, I doubt prosecution would matter much: Even if the courts somehow decided to levy murder charges + seek the death penalty, that wouldn't be enough a deterrent for UnitedHealth's leadership. At this point, it looks like criminal murder charges (seeking the death penalty) + federalizing the company would be minimal next steps towards fixing the problem. Of course, that won't happen under the current administration.
  - nothercastle 1y ago
    How about a golden parachute instead
UncleMeat 1y ago
The article claims that nursing homes were pressured to add DNRs to people's records against their will. That's not just near a the line. That's not just over the line. That's "absolute fucking evil" territory.
- fzeroracer 1y ago
  I'm old enough to remember when Sarah Palin was yelling about insurance death panels and how bad universal healthcare was. Somehow it always ends up as projection, and none of those same people will care about literal death panels.
  - 13_9_7_7_5_18 1y ago
    [dead]
- hackernewsdhsu 1y ago
  [flagged]
  - deleted 1y ago
    [deleted]
- tekla 1y ago
  Oh please, DNR is a complicated territory. Sometimes people are unable to vouch for themselves, or demand very invasive procedures. It's easy to claim that others deserve to have their demands met about procedures in the face of rational argument. My parents have a DNR because they are both doctors and have spent too much time forcibly keeping people alive-ish because they were ordered to keep people on the edge of death alive, consuming incredible amounts of money, manpower, probable pain, and medication to keep someone barely alive for a week or two. So many people are kept alive in arguably incredibly painful and shitty situations because of the inability to deal with the fact that sometimes people die
  - UncleMeat 1y ago
    DNRs can be absolutely great things when people make the choice willingly. My grandmother chose to die rather than have invasive procedures performed that gave her a small chance of living in large part based on her experience seeing her sister live miserably after her stroke. But marking somebody as having a DNR when they do not want one is evil.
    - tekla 1y ago
      It is HARD to figure out if someone actually knows what a DNR entails if they do not know what it actually requires. Everyone can easily make a choice willingly to not file a DNR if they do not know what that requires. So now your grandmother is getting is a intubation tube shoved down their throat, chest compressions, and whatever and is not a state to figure out "wow this fucking sucks" anymore, also someone just collapsed your rib-cage giving you chest compressions. Keep you alive at all costs is easy to agree to if you have no fucking clue what "all costs" mans
      - hedora 1y ago
        So, assuming I own some stock in your insurance company, it'd be ethical for me to register a DNR for you without your knowledge, then pay anyone that's supposed to transfer you to a hospital to not do it? That's exactly the behavior you're defending.
FireBeyond 1y ago
It gets worse, and on both sides of the coin. I was a paramedic (and before, an EMT) who has responded literally thousands of times to SNFs (skilled nursing facilities). Dozens, if not hundreds of these calls were for the most trivial of concerns. A nurse told us at one facility that their policy was "anything larger than a bandaid, call 911", so we'd do "first aid" while two nurses stood by and watched us. I'm sure they (the facility) had motivations on liability, etc., but nonetheless, it was utterly galling that you'd leave such a facility and see big proud billboards or ads offering "24/7 nursing care!" - and knowing that they were certainly charging the patient or their family for a rate commensurate with that, potentially five digits a month, while offloading all their work to 911 and relying on skeleton crews of an LPN per floor supervising way too many CNAs. They'd also routinely "forget" to fill out paperwork on ambulance necessity (Medicare, and many insurers, have paperwork to justify why the patient was not suitable for private vehicle or wheelchair van transport and instead needed a "fully equipped BLS/ALS ambulance"). It wasn't onerous, a single pager with a bunch of checkboxes, "Does the patient pose a fall risk?" "Need for oxygen?" "Unable to support themselves in a sitting position", etc. But we'd have to fight tooth and nail to get anything more than "patient name, DOB, and an illegible provider signature". Insurance would routinely reject payment, etc. UHG involved in more of these shenanigans? Not surprised. They were slapped several years ago for denying HEMS (Heli EMS, aka "Life Flight") from severe MVA / trauma scenes due to lack of pre-authorization... ("This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to his extensive multisystem trauma but we need your authorization. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, I know, it's a bit loud with the jaws of life in the background... Uhh, sure, I guess I can hold for a nurse consultation...")

nothercastle 1y ago

At what point are we willing to prosecute. That’s all that matters

hedora 1y ago
It looks like these programs were initiated under the CEO that was shot, and have continued under the new leadership. So, I doubt prosecution would matter much: Even if the courts somehow decided to levy murder charges + seek the death penalty, that wouldn't be enough a deterrent for UnitedHealth's leadership. At this point, it looks like criminal murder charges (seeking the death penalty) + federalizing the company would be minimal next steps towards fixing the problem. Of course, that won't happen under the current administration.
- nothercastle 1y ago
  How about a golden parachute instead

UncleMeat 1y ago

The article claims that nursing homes were pressured to add DNRs to people's records against their will. That's not just near a the line. That's not just over the line. That's "absolute fucking evil" territory.

fzeroracer 1y ago
I'm old enough to remember when Sarah Palin was yelling about insurance death panels and how bad universal healthcare was. Somehow it always ends up as projection, and none of those same people will care about literal death panels.
- 13_9_7_7_5_18 1y ago
  [dead]
hackernewsdhsu 1y ago
[flagged]
- deleted 1y ago
  [deleted]
tekla 1y ago
Oh please, DNR is a complicated territory. Sometimes people are unable to vouch for themselves, or demand very invasive procedures. It's easy to claim that others deserve to have their demands met about procedures in the face of rational argument. My parents have a DNR because they are both doctors and have spent too much time forcibly keeping people alive-ish because they were ordered to keep people on the edge of death alive, consuming incredible amounts of money, manpower, probable pain, and medication to keep someone barely alive for a week or two. So many people are kept alive in arguably incredibly painful and shitty situations because of the inability to deal with the fact that sometimes people die
- UncleMeat 1y ago
  DNRs can be absolutely great things when people make the choice willingly. My grandmother chose to die rather than have invasive procedures performed that gave her a small chance of living in large part based on her experience seeing her sister live miserably after her stroke. But marking somebody as having a DNR when they do not want one is evil.
  - tekla 1y ago
    It is HARD to figure out if someone actually knows what a DNR entails if they do not know what it actually requires. Everyone can easily make a choice willingly to not file a DNR if they do not know what that requires. So now your grandmother is getting is a intubation tube shoved down their throat, chest compressions, and whatever and is not a state to figure out "wow this fucking sucks" anymore, also someone just collapsed your rib-cage giving you chest compressions. Keep you alive at all costs is easy to agree to if you have no fucking clue what "all costs" mans
    - hedora 1y ago
      So, assuming I own some stock in your insurance company, it'd be ethical for me to register a DNR for you without your knowledge, then pay anyone that's supposed to transfer you to a hospital to not do it? That's exactly the behavior you're defending.

FireBeyond 1y ago

It gets worse, and on both sides of the coin. I was a paramedic (and before, an EMT) who has responded literally thousands of times to SNFs (skilled nursing facilities). Dozens, if not hundreds of these calls were for the most trivial of concerns. A nurse told us at one facility that their policy was "anything larger than a bandaid, call 911", so we'd do "first aid" while two nurses stood by and watched us. I'm sure they (the facility) had motivations on liability, etc., but nonetheless, it was utterly galling that you'd leave such a facility and see big proud billboards or ads offering "24/7 nursing care!" - and knowing that they were certainly charging the patient or their family for a rate commensurate with that, potentially five digits a month, while offloading all their work to 911 and relying on skeleton crews of an LPN per floor supervising way too many CNAs. They'd also routinely "forget" to fill out paperwork on ambulance necessity (Medicare, and many insurers, have paperwork to justify why the patient was not suitable for private vehicle or wheelchair van transport and instead needed a "fully equipped BLS/ALS ambulance"). It wasn't onerous, a single pager with a bunch of checkboxes, "Does the patient pose a fall risk?" "Need for oxygen?" "Unable to support themselves in a sitting position", etc. But we'd have to fight tooth and nail to get anything more than "patient name, DOB, and an illegible provider signature". Insurance would routinely reject payment, etc. UHG involved in more of these shenanigans? Not surprised. They were slapped several years ago for denying HEMS (Heli EMS, aka "Life Flight") from severe MVA / trauma scenes due to lack of pre-authorization... ("This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to his extensive multisystem trauma but we need your authorization. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, I know, it's a bit loud with the jaws of life in the background... Uhh, sure, I guess I can hold for a nurse consultation...")