Health Insurance Company Cheating? A LOT
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Happy Tuesday Advocates
I would like to encourage comments and suggestions from you if you have time. If there is a special topic you’d like to see please let me know. Please use the comment button below. By the way lots of deep breaths help. So do cute pictures.
Insurance Companies Cheating
I’m shocked, shocked to find that insurance companies are cheating (apologies to “Casablanca”). Thanks to Angela for pointing out this story.
Cigna to Pay $172M in Settlement of Fraud Lawsuit
Cigna will pay $172,294,350 to the US government because they violated the False Claims Act by submitting and failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare. They are the latest to settle their problem.
Of course Cigna is not alone. Four of the five largest Medicare (dis)Advantage players—UnitedHealth, Humana, Elevance, and Kaiser—face federal lawsuits alleging that efforts to overdiagnose their patients crossed the line into fraud. The fifth company, Aetna, told investors its practices were also being investigated by the Department of Justice. (link)
We have mentioned how Medicare “Advantage” works in the past. THIS IS PRIVATE INSURANCE - NOT MEDICARE. When you sign up with one of these private companies, they are paid a monthly fee for having you as a subscriber. The minimum is about $1000/month/enrollee. If they can show you are sicker than nominal they can get more than the $1000/month. And that’s what the government charged them with.
CIGNA reviewed all diagnoses for their MA plan subscribers for 5 years and increased the severity of diagnoses so they could increase the payments from the federal government. Here is a link to the story.
The New York Times did an investigation (behind paywall) on this subject last year and found most of the large insurers in the Medicare Advantage program have been accused of fraud. (Summary article link)
Here’s an example of how it works. The most common allegation is that the insurers did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit against Aetna, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.
Sure people try to cheat the government. The good news is that the government finds them and gets the money back, and can send people to prison. Here is a DOJ website where you can find a lot of these cases.
By the way this is not new. The (dis)honorable senator/ex governor of Florida (Rick Scott, oversaw the largest Medicare/Medicaid fraud on record at that time. His company HCA was forced to pay the government $1.7 billion in the early 2000s. Here is a link to the data. His company also cheated Medicaid in Florida and paid the US government another $631 million and the State of Florida $17 million. ALL TOLD OVER $2.3 billion. Just let that sink in the next time you see him on TV yammering for honest government.
Reduce the Spread of STDs
Ok - Safe Sex, Safe Sex, Safe Sex. But if there is a mistake there is help. U.S. health officials plan to endorse a common antibiotic as a morning-after pill that can be used to try to avoid some increasingly common sexually transmitted diseases. The proposed CDC guideline was released Monday, and officials will move to finalize it after a 45-day public comment period. With STD rates rising to record levels, “more tools are desperately needed,” said Dr. Jonathan Mermin of the Centers for Disease Control and Prevention. (AP News)
The proposal comes after studies found some people who took the antibiotic doxycycline within three days of unprotected sex were far less likely to get chlamydia, syphilis or gonorrhea compared with people who did not take the pills after sex.
Extra Credit ACTION
Click the comment button on the proposed guideline page if you’d like to provide a comment for the CDC on this technique to reduce the spread of disease. I did. I told them I was glad someone was investigating and found a way to reduce the spread of disease.
RESOURCES
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
By phone: (202) 224-3121
By email: democracy.io
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Plan
Reproductive Health
NARAL - Pro Choice America
Charley. NARAL’s abortion resource
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Also, this is a bit difficult to admit, but right now my substack is free.
I would like to pay into using the service, especially your voice. Where do I go? The app, the web?
Also what do so called insurance brokers get to sign you up for an advantage plan? I heard around 700 dollars.
But yep, they say they are under the same rules as Medicare but just try and get stroke care at a skilled nursing home.
And if they can they would much rather send you straight to a SNF or home with IV antibiotics than the hospital.
Excuse me, soapbox here!