Has anyone else been contacted about joining a growing whistleblower group that intends on providing the authorities with information that will help with the investigations? There is the medicare fraud probe but seems they are looking at other things too that would fall under anti-trust and claim laws.
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Heck, all they have to do is look at the relationship between UHC and Optum. Audit those transactions, no need for whistleblowers. Simple example - UHC pays Optum to review all of the Medicare Advantage claims they processed, find patients who might justify a higher paying diagnosis then the provider billed, review/see patient and history then Optum creates a new claim with "corrected" diagnosis's for UHC. Optum gets paid for a service showing Optum make money, UHC marks this as a cost. UHC gets a higher medicare payment win/win. Audit if all of the upcoding was legit.
All offshoring (growing alot every month) through OGA is through Optum (on paper, UHC saves money, Optum makes money). Payment integrity employees have to hit goals of dollars recouped (taking claim payments back from providers) and will tell you when in doubt they just recoup.
UHC downcodes professional ER claims using a program that only looks at the diagnosis codes and other codes on the claim and decides the provider should only be paid for a lower level code. There were several people against this project including one of the claim VP's saying they should check if the provider upcoded or not based on the notes/medical chart and how the patient presented as a medical review. The proposed dollars saved was very high and any disent was shutdown quick and we completed the project anyway.
Start a subreddit maybe?
I doubt they'll uncover much in the way of intentional fraud and moreso fraud via negligence / incompetence. How many critical applications do we have written or maintained by offshore teams who lied about their credentials, who have developed software that provides incorrect information?
And if you think it’s ok, I hope you don’t talk sh-t about dr-g dealing rappers in the ghetto because you’re doing the exact same thing. They say they have to do what they have to do to feed their families too, even if it hurts someone else. The only difference is your company has better lobbyists
So the person who feels fraud is ok. Well I can tell you from experience that all those members who have been denied unfairly causing them anxiety and financial distress because the company has a plan to make lots of money. You think the board cares. You think leadership cares that grandma can’t eat it buy her pills. How about having to live on the street cause the hospital billed her the denied care . This is what most people don’t see. You think someone is manically paying all those denied claims.and you worried about your livelihood. Why do you take all those learnsources for ethics. Everyone who willingly and knowingly commits fraud is guilty of that behavior if you know stuff and don’t say anything.
I hope people that think they are going to be heroic and bring down UHG realize that this will only impact and destroy the livelihood of the more employees in RIFs and drop investments more. This is hurting the people that serve others and their families. Some so called “whistleblowers” are self righteous and causing pain for others. I for one, believe there are much bigger fish to fry with laundering of tax dollars to foreign governments under the guise of helping others.
Is sending patient information offshore in which states say absolutely not considered illegal? Because this just isn't slowing down?
I can say UHG is greedy, I saw cost cutting, sneaky, backstabbing and being di-ks. But never fraudulent or illegal. This will blow away.
really? LOL, since the US government hired UHC, doesn’t that mean the government is involved in the fraud. Good luck pal.
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