UnitedHealth Group disclosed it is under Department of Justice investigations regarding its Medicare billing practices and is cooperating with the DOJ, following reports of the probes. The company has initiated a third-party review of its business policies, with an expected completion date towards the end of the third quarter. This announcement arrives after reports of potential Medicare fraud, including investigations into inflated diagnoses and pressure on doctors, prompted scrutiny of its Medicare Advantage business. Despite the ongoing investigations, UnitedHealth maintains confidence in its practices, citing independent audits that indicate their accuracy within the industry.
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US says it halts healthcare fraud schemes worth nearly $15 billion. Wow, that’s a hefty sum, isn’t it? It’s hard not to be impressed by the sheer scale of the numbers involved. Nearly $15 billion in healthcare fraud schemes stopped – that sounds like a significant victory. You can’t help but wonder, though, where all this money was going and who was benefiting.
US says it halts healthcare fraud schemes worth nearly $15 billion. The details start to emerge, and it appears this “operation” involved a huge number of players. Criminal charges have been filed against 324 defendants, and the authorities have seized over $245 million in assets, including cash and luxury goods.… Continue reading
President Trump commuted the 50-year sentence of Lawrence Duran, a Miami healthcare executive convicted in 2011 of defrauding Medicare out of $87 million. Duran, co-owner of American Therapeutic Corp., and his co-conspirators submitted 866,000 fraudulent claims, totaling over $200 million in a massive scheme involving unnecessary mental health services. This commutation follows a previous commutation granted to another defendant in the same case. Duran’s sentence was the longest ever imposed for Medicare fraud.
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UnitedHealth, a major healthcare insurer, is reportedly under investigation for potential Medicare fraud. This isn’t entirely surprising, given the complex nature of the Medicare Advantage program and the significant financial incentives involved. The investigation reportedly involves accusations of manipulating diagnoses to inflate payments.
The alleged scheme involves practices such as adding diagnoses to patient records that may not be entirely accurate, maximizing reimbursement rates. This might involve nurses actively seeking out additional diagnoses, potentially going beyond what doctors initially documented.
Another troubling aspect is the alleged practice of billing Medicare for patients already receiving care elsewhere, essentially double-dipping. This highlights a potential vulnerability in the system where insurers might game the rules for profit.… Continue reading
UnitedHealth, a major player in the healthcare industry, is currently under criminal investigation for potential Medicare fraud, as reported by the Wall Street Journal. This isn’t a new issue for the company; past instances of Medicare fraud have resulted in substantial fines and Senate hearings, yet the pattern of alleged misconduct seems to persist. The current investigation highlights a disturbing trend: companies facing serious allegations, whether criminal or civil, often seem to escape significant repercussions, paying fines that are a mere fraction of their ill-gotten gains and continuing their allegedly questionable practices.
The scale of the alleged fraud is significant, impacting millions of individuals and raising serious ethical questions.… Continue reading
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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John Q. Hosedrinker 
Matt Underwood