The whole fucking system is corrupt. Anything to make or steal another buck.
Medicare Advantage pays a multiple of a base rate per diagnosis. I was Director of Integrations. We would buy private practices that had a pretty big Medicare Advantage panel. Convert them to WellMedās plan (owned by Optim, owned by United). Then we would drive the doctors to diagnose everyone with everything. United has software that takes all of the patientās data and uses it to predict basically EVERYTHING they could possibly have. Then that is sent to the doctor to just sign off on. Doctor bonuses a percentage of the income.
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Thanks for your candor Doog. Thats some valuable insight. 
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This is interesting. Itās also what medical providers and provider groups do to private insurance companies.
In Unitedās case, I would be curious if there was a concerted effort to not only drive up medical billing, but also price United Healthcare in a way it accommodated price fixing by United Health Group, which would be problematic.
Doesnāt seem to be the direction of the investigation, however.
This scenario as laid out in the linked article is showcasing provider abuse, and they got in trouble because they were doing it to the govāt in this case.
Iām moving back into private practice and enduring the fuckery of credentialing with insurance companies as my own group. As such, I donāt have time for online debate, but this thread is on my mind.
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