UnitedHealth Doctors Got Diagnoses Checklists To Boost Medicare Payouts
The Wall Street Journal reports how UnitedHealth provided lists of potential, often obscure diagnoses to its doctors and forced them to weigh in on them for each Medicare Advantage patient, in order to capitalize on the government system that pays private insurers based on how sick doctors say a patient is.
The Wall Street Journal:
UnitedHealth’s Army Of Doctors Helped It Collect Billions More From Medicare
Like most doctors, Nicholas Jones prefers to diagnose patients after examining them. When he worked for UnitedHealth Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them. UnitedHealth only did that with the Eugene, Ore., family physician’s Medicare Advantage recipients, he said, and its software wouldn’t let him move on to his next patient until he weighed in on each diagnosis. (Weaver, Wilde Mathews, and McGinty, 12/29)
The Wall Street Journal:
How UnitedHealth Became An American Goliath
An outpouring of public rage against health insurers in the wake of the killing of a top UnitedHealth Group executive has drawn scrutiny to the country’s largest healthcare company. UnitedHealth recorded $372 billion in revenue last year—making it about the same size as Apple. It owns the biggest U.S. health insurer, and has expanded into almost every corner of the medical field. (Maremont, Dougherty and Wilde Mathews, 12/31)
Modern Healthcare:
Steward Health Can Close Sharon Regional Medical, Judge Says
A federal bankruptcy judge has approved Steward Health Care’s plan to close Sharon Regional Medical Center in Pennsylvania Jan. 6. Judge Christopher Lopez, of the U.S. Bankruptcy Court for the Southern District of Texas in Houston, signed off on the Dallas-based health system’s request to close the Pennsylvania hospital, according to a Dec. 27 court filing. Steward can sell or abandon any personal property left at Sharon Regional Medical Center, the filing said. (Tepper, 12/30)
Stat:
Pfizer Drops Hemophilia Gene Therapy, Imperiling Partner Sangamo
Pfizer has abandoned development of a hemophilia A gene therapy it licensed from Sangamo Therapeutics, a move that could imperil Sangamo’s future. It’s a sudden turnabout for Pfizer, which had indicated it would bring the experimental treatment to regulators, albeit not one that is likely to have a significant impact on the pharma giant or patients. Another gene therapy for the rare bleeding disorder was approved last year but has mustered little interest, largely because standard-of-care is already high and gene therapies aren’t yet curative. (Mast, 12/30)
Modern Healthcare:
Evernorth's Matt Perlberg Bullish On Specialty Pharmacy Market
Evernorth Health Services sees expanding opportunities in the $400 billion specialty pharmacy market, said Matt Perlberg, president of pharmacy and care delivery for the Cigna subsidiary. Cigna identified specialty pharmacy as a target for accelerated growth this year, and the future is bright as more of these high-cost drugs reach the market to meet rising patient demand, Perlberg said. (Berryman, 12/31)
