UnitedHealth Group Under Senate Scrutiny for Medicare Advantage Strategies
A recent Senate report has spotlighted UnitedHealth Group's strategies to secure higher-paying Medicare Advantage diagnoses. Initiated by Senate Judiciary Chair Chuck Grassley and spurred by The Wall Street Journal's earlier coverage, this investigation involved reviewing 50,000 pages of documentation to explore the carrier's billing and coding practices. The report revealed that in 2021, $8.7 billion was linked to payer-added diagnoses, although UnitedHealth contested these claims, citing incomplete and inaccurate analysis. Parallel investigations by the Justice Department are ongoing, with UnitedHealth collaborating in these inquiries.
The report, while not alleging direct misconduct, shed light on practices like home visits by nurses for diagnosis collection, incentivizing physicians to consider additional diagnoses, and utilizing AI-driven solutions for detecting new patient diagnoses. Specific conditions such as atrial fibrillation and chronic obstructive pulmonary disease were highlighted in the findings. The HouseCalls initiative, part of UnitedHealth's strategy, had nurse practitioners conducting screenings for peripheral artery disease using the QuantaFlo device, although its use was discontinued after Medicare regulatory changes. Despite share price fluctuations following adjustments in federal risk management, UnitedHealth has refined its screening methods for enhanced efficiency.
Compliance and Industry Response
A UnitedHealth spokesperson, in a report by Becker’s Healthcare on January 12, emphasized the company's dedication to compliance with CMS requirements and highlighted the clinical and compliance standards upheld by their programs. UnitedHealth continues to work with CMS and other entities to improve program effectiveness while refuting the committee's depiction of its Medicare Advantage coding practices and the HouseCalls service. The company underscored studies demonstrating the cost efficiencies of the Medicare Advantage program. As the regulatory examination expands, attention is also turning towards UnitedHealth's practices in nursing home operations.