Major insurance companies have been “bilking” Medicare Advantage (MA) for years through upcoding, according to Benjamin Poehling, the one-time UnitedHealth executive who has filed a whistleblower lawsuit against his former company.
In an interview with the New York Times, Poehling said he monitored data-mining projects to find conditions which could increase UnitedHealth’s MA payments. His team would receive bonuses for hitting revenue targets, not for improving patient outcomes or finding conditions which couldn’t raise risk scores and reimbursements.
“You or I or the average person is probably appalled by this,” Poehling said. “But the scheme here was not about delivering better care to members—the thing you would expect from a health care company. It was about increasing the bottom line.”
UnitedHealth has denied the allegations, first made in a sealed lawsuit in 2011.
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John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.