Fwd: Yet another way to pad their pockets
Craig Brooks
Begin forwarded message:
From: Be A Hero Team <in...@beaherofund.com>
Date: August 11, 2024 at 5:45:41 PM CDT
To: Craig....@gmail.com
Subject: Yet another way to pad their pockets
Reply-To: in...@beaherofund.com
Craig, recently the Wall Street Journal published an article about insurance companies using Medicare Advantage to pocket $50 BILLION in public dollars for unconfirmed diagnoses added by the insurance companies themselves.
Now, the Journal has published another article about a shady practice that helps the insurance companies make that $50 billion:
In their newest exposé on Medicare (dis)Advantage, they investigated the insurance company practice of sending nurses for one-hour visits to patients’ homes.
The goal? These nurses gather new, often inaccurate, diagnoses that Medicare Advantage insurers then report to collect extra money from the federal government.
This practice not only collects billions from Medicare that could be going to make healthcare more affordable, it also brings up dangerous diagnoses that then confuse and scare patients.
If you’ve saved your information with ActBlue Express, your donation will process instantly.
“The Wall Street Journal investigation of insurer home visits found the companies pushed nurses to run screening tests and add unusual diagnoses, turning the roughly hourlong stops in patients’ homes into an extra $1,818 per visit, on average, from 2019 to 2021. Those payments added up to about $15 billion during that period, according to a Journal analysis of Medicare data.”
The Wall Street Journal reporting team connected with Shelley Manke, a nurse practitioner who worked for UnitedHealthcare who, along with a “small army” of nurses called the HouseCalls unit, was making at least 6 visits to folks’ homes a day.
She said that a part of her routine was to warm up the big toes of her patients and use a portable testing device to measure how well blood was flowing to their extremities — a practice that could help them flippantly diagnose a patient with peripheral artery disease, a narrowing of blood vessels.
Each case they diagnosed would earn the company an extra $2,500 or so. More than 700,000 peripheral artery disease cases diagnosed only during home visits added $1.8 billion in payments from Medicare to private insurance companies from 2019-2021.
Yet, when Manke tested the device herself, she got an array of results. She and other nurses told their managers they didn’t trust the device, but was told that “the company believed that data supported the tests and that they needed to keep using the device.”
And that wasn’t all. More nurses the Wall Street Journal interviewed said many of the diagnoses that home-visit companies encouraged them to make wouldn’t otherwise have occurred to them — and in many cases were unwarranted.
“They do the job with a purpose, and it pays off for the Medicare Advantage plans,” said Francois de Brantes, a former executive at Signify Health, a company that does home visits for insurers. “Identifying the diagnoses, that’s the job.”
Companies claim they are trying to catch diseases early and make sure patients are doing ok, but we know these nurses are being used as part of a system, which includes software, algorithms, audits, AI, and more, used by insurance companies to rake in the profits from Medicare.
Be A Hero Team
Paid for by Be A Hero Action Fund. Contributions or gifts to Be A Hero Action Fund are not tax deductible.
