This story appeared recently in the New York Times relating the story of Benjamin Poehling, a former finance director at United Health Group, one of the largest health insurers in the country. Mr. Poehling is now a whistleblower who says the major insurance companies have been engaged in a scheme to bilk Medicare out of billions of dollars.
The New York Times story says: “When Medicare was facing an impossible $13 trillion funding gap, Congress opted for a bold fix: it handed over part of the program to insurance companies, expecting them to provide better care at a lower cost. The new program was named Medicare Advantage… But now a whistleblower…asserts that the big insurance companies have been systematically bilking Medicare Advantage for years, reaping billions of taxpayer dollars from the program by gaming the payment system.” The Times story goes on to say that Mr. Poehling “described in detail how his company and others like it – in his view – gamed the system: Finance directors like him monitored projects that United Health had designed to make patients looks sicker than they were, by scouring the patients’ health records electronically and finding ways to goose the diagnosis codes. The sicker the patient the more United Health was paid by Medicare Advantage – and the bigger the bonuses people earned…”
When insurance company executives allow their own financial interests to be placed ahead of those of everyone else, including the American taxpayer, something has gone wrong at the heart of the industry. Placing profits and personal bonuses ahead of all other considerations, including honesty, fairness, the health and welfare of policyholders and the tax dollars of all Americans is the act of a company run amok.