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United gets paid more via reimbursements for MA patients when they have HCC risk-coded conditions.
So here’s what they did-
They bought it all up. When you hear “optum” that’s United.
They own the insurance, the provider systems, home health, ASCs, and pharmacy (optumRX)
And on top of that, they took all that data that only they are privy to, and sell it to everyone else. They even have Optum Bank, for HSAs.
They are controlling the whole flipping thing. This one entity is the biggest problem.
So they don’t overbill actually, that would cost them money. What they do is spend less on visits / healthcare spend and in turn train coders and doctors and other tactics to say WOW this person is super sick, we need more money from the government, but we also will do the minimum to actually provide care or drugs to the person.
Because that’s how they make the most money. There’s a great report out there about how they’ve literally forced nurses to not follow appropriate protocols for nursing home patients, pushing them towards their death.
United will definitely not face the punishments they deserve. They will be fined and carry on.
Why? Because each player in this healthcare space lobbies for themselves - and don’t focus on the biggest problem which is vertical integration. We need much stronger antitrust enforcement.
Conglomerates and monopolization. It has to end.
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