This was an interesting case as you can ask almost any doctor out there about United Reimbursements and the complex contracts they have for providers to sign. I have heard quite a few myself in discussions with doctors over the years to even include taking money back if they determine they over paid on a claim out of current reimbursements checks, in other words the money comes out of current claim money coming in. It’s a huge accounting nightmare for doctors with assignment of payment too. Actually too the American Academy of Family Practice Physicians has also confronted United on their contracts where as due to complexities, models and formulas, the net payments to doctors in several parts of the US ends up being less than what Medicare pays. Some MDs in the south have told me due to the contracts that are out there the Medicare ends up being the best payer in town.
The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job
It’s all about payment models and United is the king of complexities out there. If you look at the want ads you can’t help but see the huge number of quants, analysts, data miners they are looking to hire, it’s about 70% of their employment ads. You have to really look at the truckloads of subsidiaries this company has, it’s huge and a lot is in the Health IT business. Just use the Google search box and put in “subsidiary watch” and you’ll find tons of posts on their subsidiaries. Here’s a great article stating we don’t need more complicated models, we need to stop lying with our models.
They hired from HHS, Steve Larsen who was primarily responsible for writing the healthcare law, so now he sits as a VP at United at the Optum division. Press releases like this come out from the company…so with all of this and other related articles in the news was it maybe not a surprise that the jury noticed the reduced reimbursements the doctor was receiving?
UnitedHealthCare Looks at Doctor’s Pay for Savings, Nothing New There Been Doing It for Years But Keep In Mind We Have the Annual Medicare Cut Fix on the Floor Again with Congress–Timing?
They do like to go to court I think and last year hired the former US Assistant Attorney General from the state of Minnesota as general counsel. They want a contract they sued and we have never heard the entire background of this Tri-Care suit other than the DOD caved in and gave them the contract of they made enough noise as they had protested before the lawsuit too. With all the complex analytics the conglomerate has, perhaps it was the old “throw numbers at them” that helped? I don’t know but they put out these bogus studies that claim to save “trillions” all the time. When these studies graduate from billions to trillions, that’s your first indicator of a weird model with some non linear processes in place. Models can lie, so again I use my common sense when I hear trillions in savings claimed out there:)
Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?
Again the jury it sounds like found reimbursements were part of the reason that the doctor was skimping and re-using equipment along with a low ball contract, where it should not have been to save money. It will be interesting to see what comes out of the AAFP issue too or if it gets addressed at all. BD
Two companies—both subsidiaries of publicly traded UnitedHealth Group Inc.—signed a low-bid contract with the physician who ran the clinic where the outbreak started, despite warnings that he sped through procedures and pinched pennies at his clinics so much that patients were at risk of contracting blood-borne diseases, attorneys for those suing the companies argued.
"The jury sent a strong message not only to HPN and Sierra Health, but to every HMO and health insurance company in this country," Eglet said. "You've got to provide a fair and responsible reimbursement rate to medical providers so that they are able to provide quality health care to their insured members."