Oh boy, we have some serious news to share today.
In a recent class action lawsuit against UnitedHealth Group, allegations about using an algorithm to deny rehabilitation care to seniors enrolled in Medicare Advantage plans have surfaced.
Medicare is our federal health insurance program. Medicare Advantage plans are run by private companies that contract with Medicare to provide insurance to seniors. Most people eligible to enroll are choosing Medicare Advantage plans (51%).
As reported by STAT News:
“The class action suit, filed on behalf of deceased patients who had a UnitedHealthcare Medicare Advantage plan and their families by the California-based Clarkson Law Firm, follows the publication of a STAT investigation Tuesday. The investigation, cited by the lawsuit, found UnitedHealth pressured medical employees to follow an algorithm, which predicts a patient’s length of stay, to issue payment denials to people with Medicare Advantage plans. Internal documents revealed that managers within the company set a goal for clinical employees to keep patients rehab stays within 1% of the days projected by the algorithm.”
But here’s the real shocker – this algorithm has an error rate of 90%!
That means so many seniors who need rehabilitation care are denied because of this faulty algorithm. It’s unbelievable and downright infuriating.
The plaintiffs leading this class-action lawsuit are the families of deceased patients who have experienced the heartbreaking effects of this algorithmic denial of care firsthand.
Medicare Open Enrollment Is Underway
As we navigate the Medicare open enrollment period, this is a powerful reminder that corporations run Medicare Advantage plans.
“UnitedHealthcare, alone, accounts for 29% of all Medicare Advantage enrollment in 2023, or 8.9 million enrollees.”
KFF
If you know anyone who is considering their Medicare enrollment, share this information with them.
As privately held companies, they do not share the data needed for seniors to make informed decisions about the effectiveness of Medicare Advantage plans.
For example, we don’t know how often Medicare Advantage insurance companies deny payments for services covered by Medicare. How often do they require prior authorizations? How long does it take to process prior authorization requests? How often are prior authorizations denied? We don’t know because they don’t share the data.
As privately held companies, it is not a stretch of the imagination to assume that they prioritize profits over patients.
