Care Denials By UnitedHealth Were Driven By Algorithms, Staff Allege

Stat: UnitedHealth Used Algorithms To Deny Care, Staff Say 
The nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation care for older and disabled Americans as profits soared, a STAT investigation has found. (Ross and Herman, 11/14)

In news about the Veterans Administration —

The Denver Post: Head Of VA Prosthetics Department In Colorado Canceled Veterans’ Orders To Eliminate Backlog, Ex-Employees Allege 
In 2021, an employee with the Department of Veterans Affairs in Aurora, Colorado, alerted leadership to a troubling practice within the federal agency's Eastern Colorado Health Care System, a vast network providing services for 100,000 veterans. The whistleblower worked for the Prosthetic and Sensory Aids Service, which supplies military veterans with artificial limbs, wheelchairs, surgical implants, glasses, hearing aids and other devices to help them live more functional lives. (Tabachnik, 11/13)

Military Times: Vets Tap Businesses For VA Disability Claims Help, But There’s A Cost
When Navy veteran Melissa Washington wanted to reapply for an increase in her disability benefits, she selected a for-profit firm — Veterans Benefits Guide — to cut down on the paperwork and preparation she’d have to do herself. “I knew a lot of people who had already been through the process, and I wanted to try for myself,” said Washington, who runs the Women Veterans Alliance in Sacramento, Calif. ... The 51-year-old, who has been out of the service for almost 30 years, said the process cost her a few hundred dollars and just a few months of waiting. She said she will recommend the process to friends and clients interested in getting help with their claims. Veterans advocates say it’s illegal. (Shane III, 11/13)

In hospital updates —

NBC News: State Attorney General, Doctors And Nurses Criticize HCA Over Patient Care At North Carolina's Mission Hospital
Four years after it bought Mission Hospital, an 815-bed facility in Asheville, North Carolina, HCA Healthcare is under fire in the region, threatened with a lawsuit by the state attorney general and facing criticism from nurses and at least 124 current and former Mission doctors who say HCA, the nation’s largest for-profit hospital chain, is imperiling patient care at the facility in its pursuit of profits. “Profits over people is not an ethic, model, or aspiration that can deliver the quality of care we all expect and deserve.” (Morgenson, 11/13)

Minnesota Public Radio: Survey: Minnesota Hospitals Report Hefty Financial Losses
The Minnesota Hospital Association reported Monday that many of the state’s health systems are losing money at a growing clip. The MHA, a trade group that represents care providers that include large Twin Cities health systems and small rural hospitals, said that 67 percent of its members that took part in a recent survey reported losses in the first half of 2023. That’s a sharp increase over the 55 percent that reported negative operating margins in 2022. (Sepic, 11/14)

The Boston Globe: Cooley Dickinson Hospital In Northampton Pauses Elective Surgery
Cooley Dickinson Hospital in Northampton has had to reschedule an undisclosed number of surgeries since Nov. 6 due to a problem with the equipment that sterilizes certain medical instruments and devices on site. The hospital said it was pausing elective procedures that use the affected instruments, but it was proceeding with procedures that use equipment and devices that are sterilized off-site. (Bartlett, 11/13)

The CT Mirror: Medical Staff, CT Legislators Rally For Prospect Hospitals’ Sale To Yale
Nurses, physicians and legislators — frustrated at the length of time the state has taken to approve the acquisition of three Connecticut hospitals by Yale New Haven Health — rallied at the state Capitol Monday in an effort to expedite the deal. (Carlesso and Altimari, 11/13)

Modern Healthcare: New York Hospital Cybersecurity Proposal Aims To Protect Data
The state of New York is proposing regulations that would tighten cybersecurity requirements for hospitals, Gov. Kathy Hochul’s office said Monday. The proposed rule would require hospitals to establish a cybersecurity program and take steps to assess internal and external risks. The rule will publish in the state register on Dec. 6, with a 60-day comment period ending Feb. 5, 2024. (Perna, 11/13)

Also —

Modern Healthcare: Healthcare DEI Programs Contend With Anti-'Woke' Movement
Following years of investment in diversity, equity and inclusion initiatives, the healthcare sector is now grappling with the anti-"woke" movement. After Florida Gov. Ron DeSantis (R) enacted the Stop Wrongs to Our Kids and Employees Act—better known as the Stop WOKE Act—last year, for example, Trinity Health had to add a disclaimer to its workforce trainings on structural racism: No one person is responsible for the history of slavery in America. (Hartnett, 11/13)

Axios: How AI Deepfakes Could Make Health Care Misinformation Worse
For all the promise that artificial intelligence holds for health care, one of the industry's big fears is its potential to churn out more convincing misinformation. AI experts are warning that tech used to create sophisticated false images, audio and video known as deepfakes is getting so good it could soon become almost impossible to distinguish fact from fiction. (Reed, 11/14)

Modern Healthcare: Modern Healthcare's 40 Under 40 Awards Seek Nominations
Modern Healthcare is seeking nominations for our 40 Under 40 awards that recognize the industry’s rising stars and next generation of leaders. The program builds upon our previous recognition programs for young professionals, including Emerging Leaders and Up-and-Comers. Nominations are open and will be accepted through Dec. 11. We’re looking for influential young executives across all sectors of healthcare, including providers, payers, vendors, suppliers, government agencies and associations. To be eligible, nominees must be 40 years of age or younger as of Dec. 31, 2023. (11/13)