(Dmytro “Henry” Aleksandrov, Headline USA) An analysis of billions of Medicare records showed private insurers connected to the federal government’s $450 billion-a-year Medicare program issued “hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments from 2018 to 2021.”
The program covers over half of the 67 million seniors and disabled people on Medicare, the Wall Street Journal reported. The program said that insurers can add their diagnoses and the ones doctors submit for their patients.
“Medicare gave insurers that option so they could catch conditions that doctors neglected to record. The Journal’s analysis, however, found many diagnoses were added for which patients received no treatment, or that contradicted their doctors’ views. The insurers make new diagnoses after reviewing medical charts, sometimes using artificial intelligence, and sending nurses to visit patients in their homes,” the news source wrote.
The Journal also stated that Medicare paid “doctors for access to patient records, and reward patients who agree to home visits with gift cards and other financial benefits.”
Medicare compensated insurers roughly $50 billion for diagnoses the insurers had added between 2018 and 2021.
“The government paid all Medicare Advantage insurers more than $700 million from 2019 to 2021 for diabetic cataracts. Most of the diagnoses were added by insurers,” the news source reported.
Even though they had previously received cataract surgery, over 66,000 Medicare Advantage patients were diagnosed with diabetic cataracts.
“It’s anatomically impossible. Once a lens is removed, the cataract never comes back,” Dr. Hogan Knox, an eye specialist at the University of Alabama at Birmingham, said.
However, UnitedHealth spokesman Matthew Wiggin said the Journal’s analysis was “inaccurate and biased,” adding that Medicare Advantage “provides better health outcomes and more affordable healthcare for millions of seniors” than traditional Medicare.
A spokesman for Humana also said that the Journal’s analysis of treatment rates “is flawed and misleading.”
