United Healthcare & Medicare Fraud?
 

Recent headlines say United Healthcare is under criminal investigation by the DOJ for possible Medicare fraud. :shocked:

I have not yet read the details. It seems to be related to Advantage plans, but the WSJ article is behind a paywall. (I will pay for my grandfathered UNH Plan F — but I resist paywalls. Go figure.)

UNH stock has been more than cut in half. If the company is found guilty of criminal fraud, will the guilty, powerful ones go to jail? (HAH)

Will the company survive?

Will Plan F and Plan G survive? (I like the choice those plans give, even though the cost of the premiums is higher. A friend who worked in geriatric care told me to never give up Medicare as primary and to add a supplement. We took that advice and have been glad we did, but losing that choice feels like a possibility.)

There are so few companies in that business, if UNH is taken out, then what?

Is this DOJ investigation just the tip of the iceberg? Are the ice floes looming?

Boomer

Medicare fraud is so rampant, it is difficult to believe that this is even a news story.

This United Health Care problem only has to do with the Advantage plans and not their Medicare Supplement plans like F and G etc.

There was a time when I would have totally agreed with that statement, but not this time. This one could grow arms and legs more than usual.

Boomer

I understand that, but if the company is under investigation for their Advantage plans, all premiums could be affected and perhaps even availability in general. There is not a whole lot of competition in the business.

Boomer

I read about Miami being the capitol of Medicare fraud in one of this brilliant man's books (I have read them all!), "Revenge of the Tipping Point". Malcolm Gladwell on why Miami is the U.S. Medicare fraud capital | WLRN

As long as you are currently in a supplemental plan you can switch to a different provider without medical underwriting. I would recommend switching to Blue Cross Blue Shield, they are a solid company. It was a no brainer for us to get plan G from them.

As I understand it, supplement plans are designed to pay the 20 percent co-insurance that original Medicare doesn't pay. They are piggy-backed to original Medicare, and they only pay after original Medicare has approved the 80 percent payment. So, in fact, supplement plans don't really approve any claims on their own. They just wait for the Government to approve a claim and then they pick up the 20 percent co-insurance. If the Government denies the claim, then the supplement plan pays nothing.

In contrast, Advantage plans are managed by private insurance companies, and they don't use supplement plans to cover any co-insurance.

My decades of business experience tell me that if one company is exploiting something or defrauding, it is highly likely that other companies are too.

So, yes, it could become a much bigger story. It's not a shocker to me, in the slightest.

Snooze.

The sky is falling the sky is falling.

It’s much too early to seriously consider all of that.

As of now, news of a criminal investigation has been leaked to the media. No official notifications of a criminal investigation or indictment has occurred. It may or may not turn into something serious against the company. The media loves to speculate—-and they will.

I read in a business paper yesterday that this may be why Andrew Witty suddenly resigned as CEO.

“I read in a business paper”

The media loves to speculate.

United Health objected to the article implying it was not true. That may well be, hedge funds that short stocks often plant fake stories. We will see.

I agree, most supplement plans are fraudulent…. What we get when we don’t read what’s in it…