Becker's Healthcare December 30, 2024
UnitedHealth Group has optimized its ability to increase Medicare Advantage members’ sickness scores and corresponding government payments by directly employing thousands of physicians at Optum and integrating sophisticated software tools into clinical workflows, according to a Dec. 29 investigation from The Wall Street Journal.
CMS bases Medicare Advantage payments on patient risk scores derived from medical diagnoses. According to the report, UnitedHealth uses software to suggest potential diagnoses for patients, which physicians must address before completing patient visits. These diagnoses are often obscure or minimally substantiated, physicians formerly employed by the company told the WSJ. The report found that sickness scores for UnitedHealth patients transitioning from traditional Medicare increased by 55% during their first year in a Medicare Advantage plan,...
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