The Department of Justice’s recent investigation into UnitedHealth Group’s Medicare billing practices is raising significant questions about the company’s methods and the potential for widespread fraud. The investigation, ongoing for several months, centers on allegations that UnitedHealth incentivized doctors to over-diagnose patients, leading to inflated Medicare reimbursements.
This isn’t just about a few extra charges; the accusations involve systematic practices. Doctors reportedly claim that UnitedHealth provided training on how to document revenue-generating diagnoses, even ones deemed obscure or irrelevant by the physicians themselves. The company also allegedly employed software to suggest conditions, offering bonuses to doctors who adopted these suggestions. This raises serious concerns about the integrity of the billing process and the potential for substantial financial abuse of the Medicare system.… Continue reading
Alexandra Gehrke and Jeffrey King, an Arizona couple, pleaded guilty to a $1.2 billion healthcare fraud scheme. Their companies, Apex and Viking Medical Consultants, submitted false claims to Tricare, CHAMPVA, and Medicare for unnecessary wound treatments. The couple, lacking medical training, incentivized sales representatives to maximize reimbursements, regardless of patient need. Facing up to 20 years imprisonment each, they agreed to pay substantial restitution and forfeit seized assets.
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In Brockton, Massachusetts, three individuals—Dinora Cardoso’s daughter and granddaughter, and a visiting nurse—face charges related to the 79-year-old’s death from severe neglect. The victim was found severely malnourished, infested with bedbugs and cockroaches, and fused to a feces- and urine-soaked mattress. This horrific condition, resulting from months of neglect, led to severe infections and ultimately, her death. The three suspects are facing charges including manslaughter and Medicare fraud, with bail set at varying amounts and conditions restricting contact with vulnerable populations and travel.
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Rick Scott, a leading contender for Senate Majority Leader and a staunch supporter of Donald Trump, has a history of legal troubles, including a $1.7 billion settlement stemming from a massive Medicare fraud case against his former company, Columbia/HCA. While Scott has acknowledged “mistakes” made by the company, he has also compared his legal issues to the criminal cases against Trump, describing both as “political persecution”. Scott’s past and his recent political maneuvering have drawn attention to his potential leadership role in the Senate should Republicans regain control.
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Matt Underwood 
John Q. Hosedrinker