[CoachKandSportsguy]

UNH is an insurance company who is profit motivated above all else.

paywalled source: wsj.com

exec summary: Added diagnoses to patients’ records for conditions that no doctor treated, which triggered an extra $8.7 billion in federal payments. Untreated diagnoses from in-home visits by nurses cost an avg of $2,735 in additional federal payments per visit.

If the government wanted to eliminate fraud, hiring more inspectors general and attorneys to prosecute, and increased the size of the court system for more throughput, would be the best answer, instead of cutting basic services. .

[ROCKETMAN]

I think of all the fraud Medicare and Medicare would be in the billions. Doctors ordering unnecessary tests, people not looking at their bills to see if they actually had this test, and the reasons go on forever. Unfortunately it’s so massive with the number of elderly increasing every day this would be a huge undertaking. And Medicare nursing homes that’s a story for another day.

[OrangeBlossomBaby]

And now, you won't be allowed to use telehealth anymore for MOST situations. Effective April 1. Telehealth became a "thing" during the pandemic when it wasn't really safe for everyone with COVID to be hanging out in the waiting room with healthy people just looking for a brief consultation with a doctor or nurse about a generic ache or muscle cramp.

But it became popular AND cost-effective for both the medical professionals and the patients. Patients who are home-bound, who -cannot- sit up by themselves and don't have handi-vans to roll their wheelchairs into, will not be able to get the care they need for routine visits anymore. They'll have to hire a handi-van from an ambulance company, which isn't covered by Medicare, and go ONLY to a doctor that has either really strong people or a hoyer lift to put them onto the exam table, and the process will take several hours instead of several minutes.

Talk about waste of taxpayer dollars.

[golfing eagles]

Originally Posted by ROCKETMAN

I think of all the fraud Medicare and Medicare would be in the billions. Doctors ordering unnecessary tests, people not looking at their bills to see if they actually had this test, and the reasons go on forever. Unfortunately it’s so massive with the number of elderly increasing every day this would be a huge undertaking. And Medicare nursing homes that’s a story for another day.

IMHO, the amount of fraud is in the tens of billions. Insurance companies adding diagnoses is fraud, same for hospitals and doctors.

"Unnecessary" tests are not fraud , and are driven by one thing and one thing only-----LAWYERS

It is estimated that the defensive practice of medicine costs us $600-700 BILLION/year. Want to cut costs?-----limit so called "pain and suffering" awards and penalize lawyers that bring frivolous lawsuits. There is real malpractice from unqualified or impaired providers, but that is a small fraction of what is going on---the majority of lawsuits are for "maloccurence"---a bad outcome through no fault of the provider.

[golfing eagles]

Originally Posted by OrangeBlossomBaby

And now, you won't be allowed to use telehealth anymore for MOST situations. Effective April 1. Telehealth became a "thing" during the pandemic when it wasn't really safe for everyone with COVID to be hanging out in the waiting room with healthy people just looking for a brief consultation with a doctor or nurse about a generic ache or muscle cramp.

But it became popular AND cost-effective for both the medical professionals and the patients. Patients who are home-bound, who -cannot- sit up by themselves and don't have handi-vans to roll their wheelchairs into, will not be able to get the care they need for routine visits anymore. They'll have to hire a handi-van from an ambulance company, which isn't covered by Medicare, and go ONLY to a doctor that has either really strong people or a hoyer lift to put them onto the exam table, and the process will take several hours instead of several minutes.

Talk about waste of taxpayer dollars.

On the other hand, telemedicine is a poor alternative at best. There is no substitute for talking to the patient in person and hands on examining them. NONE. You cannot practice medicine over the phone. PERIOD.

[gatorbill1]

United healthcare has been excellent for me

[OrangeBlossomBaby]

Originally Posted by golfing eagles

On the other hand, telemedicine is a poor alternative at best. There is no substitute for talking to the patient in person and hands on examining them. NONE. You cannot practice medicine over the phone. PERIOD.

Telehealth isn't just a phone thing. It's also a video conference thing. If someone says "I have a new long dark line on my leg and it's sore, what should I do?" the doctor can look at it with the laptop camera, and he can ask questions - are you sore anywhere else? Feeling shortness of breath? Difficulty walking? Is it only sore when you touch it, like a bruise, or is it constantly throbbing? Are you feeling especially tired lately?

If it's just sore to the touch and you have no other symptoms, he can say "it's probably just a varicose vein. If you want we can schedule an appointment for you to come in, but it appears safe enough to leave alone for now."

And then you avoid a couple hours of dealing with going to the doctor for a varicose vein.

Telemedicine is a godsend for people who aren't merely "inconvenienced" by going to the doctor, but who put their own health at risk by leaving their homes. It's especially helpful to people who are immunocompromised, who shouldn't be sitting in a waiting room filled with sick people if they can avoid it with a simple video-chat with the doctor or nurse.

[CoachKandSportsguy]

sample size 1,

start getting to bigger sample sizes, you might find that there are some very unhappy people, and some doctors.

UNH is suing a doctor for slander after she posted actual UNH experience during surgery prep rescinding payment for pre approved surgery.

fraud generally has nothing to do with individual interactions but with billing interactions.

[CoachKandSportsguy]

Originally Posted by OrangeBlossomBaby

Telehealth isn't just a phone thing. It's also a video conference thing. If someone says "I have a new long dark line on my leg and it's sore, what should I do?" the doctor can look at it with the laptop camera, and he can ask questions - are you sore anywhere else? Feeling shortness of breath? Difficulty walking? Is it only sore when you touch it, like a bruise, or is it constantly throbbing? Are you feeling especially tired lately?

Agreed, but there are other programs which have been started under the telehealth program, such as Hospital at Home, using hospital visiting nurses to do the patient review, and then communicate with the central doctor, which moves some outpatient visit from the the clinics and ER to the home.

https://www.cms.gov/blog/lessons-cms...ome-initiative

[golfing eagles]

Originally Posted by OrangeBlossomBaby

Telehealth isn't just a phone thing. It's also a video conference thing. If someone says "I have a new long dark line on my leg and it's sore, what should I do?" the doctor can look at it with the laptop camera, and he can ask questions - are you sore anywhere else? Feeling shortness of breath? Difficulty walking? Is it only sore when you touch it, like a bruise, or is it constantly throbbing? Are you feeling especially tired lately?

If it's just sore to the touch and you have no other symptoms, he can say "it's probably just a varicose vein. If you want we can schedule an appointment for you to come in, but it appears safe enough to leave alone for now."

And then you avoid a couple hours of dealing with going to the doctor for a varicose vein.

Telemedicine is a godsend for people who aren't merely "inconvenienced" by going to the doctor, but who put their own health at risk by leaving their homes. It's especially helpful to people who are immunocompromised, who shouldn't be sitting in a waiting room filled with sick people if they can avoid it with a simple video-chat with the doctor or nurse.

Are you really trying to tell me how to take a history and physical???😂😂😂. Sorry, but it’s not that simple. The worst medical mistakes that I have seen have occurred when there was no in-person contact

[ElDiabloJoe]

Originally Posted by golfing eagles

IMHO, the amount of fraud is in the tens of billions. Insurance companies adding diagnoses is fraud, same for hospitals and doctors.

"Unnecessary" tests are not fraud , and are driven by one thing and one thing only-----LAWYERS

....

One of the biggest downfalls that has dragged the U.S. down into such a litigious society has been the decades-long lobbying influence of the U.S. Trial Lawyers Association. Tort law has been phenomenally expanded under their efforts.

[BrianL99]

Originally Posted by golfing eagles

IMHO, the amount of fraud is in the tens of billions. Insurance companies adding diagnoses is fraud, same for hospitals and doctors.

"Unnecessary" tests are not fraud , and are driven by one thing and one thing only-----LAWYERS

It is estimated that the defensive practice of medicine costs us $600-700 BILLION/year. Want to cut costs?-----limit so called "pain and suffering" awards and penalize lawyers that bring frivolous lawsuits. There is real malpractice from unqualified or impaired providers, but that is a small fraction of what is going on---the majority of lawsuits are for "maloccurence"---a bad outcome through no fault of the provider.

This an area of abuse, that folks on the receiving end of medicine, don't think about. We all know that once you're on Medicare, your health care providers can't wait to do more & more tests, and once you're "in the system", you'll be bombarded with tests and procedures they want to schedule.

The risk of malpractice lawsuits, is a daunting cloud that apparently hangs over the medical profession. In Massachusetts, it's almost impossible to sue for malpractice. In order to actually get anywhere with a lawsuit, the action has to be "validated" by a review board and the bar is fairly high.

I had a doctor who wildly misdiagnose an issue and like most everyone else, I was ready to sue. I talked to 3 fairly big time Malpractice attorneys, who all told me, I would be wasting my time.

I suspect other states don't have such barriers to malpractice claims and folks can sue for "maloccurance" or delayed care, due to misdiagnoses?

[CoachKandSportsguy]

The civil fraud investigation is examining the company's practices for recording diagnoses that trigger extra payments to its Medicare Advantage plans.

[blueash]

I would add that in my personal experience, n=1, the primary driver of excessive testing was not fear of lawyers but demanding patients who believed every cough needed a chest xray or later a CT. Every headache required a brain scan etc etc.

A simple reading of past medical threads here will find many postings from Villagers who helpfully suggest all the tests you should be getting for whatever medical symptom you post about.

You shouldn't worry about lawyers or malpractice if you don't commit malpractice and stay aware and conform to the standard of care. And yes, I am well aware that being innocent of malpractice is not the same as not being accused and dragged through the process.

But the original post here is correct. There is lots of fraud and firing the people who look for fraud is the exact opposite of cost cutting even if it saves the salary of the inspector that saving is completely cancelled by the lack of recovery of the fraudulent payments. And once the industries and individuals know there is no longer any oversight then the fraud, or creative accounting and billing will certainly get worse.

Same thing for IRS agents where they more than make up for their salary with increased collections of taxes owed, (a $1 increase in spending on the IRS's enforcement activities results in $5 to $9 of increased revenues. ), and the deterrent factor of not trying to get away with cheating adds even more.

[golfing eagles]

Originally Posted by blueash

I would add that in my personal experience, n=1, the primary driver of excessive testing was not fear of lawyers but demanding patients who believed every cough needed a chest xray or later a CT. Every headache required a brain scan etc etc.

A simple reading of past medical threads here will find many postings from Villagers who helpfully suggest all the tests you should be getting for whatever medical symptom you post about.

You shouldn't worry about lawyers or malpractice if you don't commit malpractice and stay aware and conform to the standard of care. And yes, I am well aware that being innocent of malpractice is not the same as not being accused and dragged through the process.

But the original post here is correct. There is lots of fraud and firing the people who look for fraud is the exact opposite of cost cutting even if it saves the salary of the inspector that saving is completely cancelled by the lack of recovery of the fraudulent payments. And once the industries and individuals know there is no longer any oversight then the fraud, or creative accounting and billing will certainly get worse.

Same thing for IRS agents where they more than make up for their salary with increased collections of taxes owed, (a $1 increase in spending on the IRS's enforcement activities results in $5 to $9 of increased revenues. ), and the deterrent factor of not trying to get away with cheating adds even more.

Agree with you as well. As you know it is very hard to tell a patient that you are not going to order some ridiculous test that he looked up on the internet