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  1. #201
    dangerous floater Winehole23's Avatar
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    UnitedHealth and other third party administrators have been screwing the public for a while

    At issue is the Veterans’ Community Care Program, which facilitates medical care for veterans provided by health care professionals outside of the Veterans Health Administration (VHA).


    The program is administered by big health insurance companies, including Optum and TriWest. Data compiled by federal investigators shows that these insurers, often called third-party administrators (TPAs), overbill the government in a similar way that insurers selling Medicare Advantage plans do, as HEALTH CARE uncovered has reported.







    Department of Veterans Affairs Office of the Inspector General (OIG) February 2025
    report.

    The investigators looked under the hood of these companies and found some real troubling signs. Their February 2025 report – published by the Department of Veterans Affairs Office of the Inspector General (OIG) – found that the VHA overpaid its TPAs by more than $1 billion between 2020 and 2024.
    The largest recipient was UnitedHealth Group’s Optum, which received overpayments of more than $105 million from 2020 to 2022. TriWest was overpaid $73.4 million from 2020 to 2023. The OIG found the overpayments were a result of the companies charging the VHA incorrect rates.

    For example, Optum reportedly overcharged the VHA by $783.4 million between 2020 and May 2024 for dental services provided by community care providers. Investigators said Optum was able to charge the extra amount because of a technicality in the contract: there was no language that specifically prevented Optum from charging the VHA more than it was reimbursing the community care provider for the service.
    https://healthcareuncovered.substack...edhealth-group

  2. #202
    dangerous floater Winehole23's Avatar
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    Trumplandia rigs the game for dirty dealing PBMs in the FTC insulin lawsuit

    The Federal Trade Commission late Tuesday stayed a lawsuit accusing pharmacy middlemen of gaming the system to inflate the price of insulin — a drug millions of Americans need to survive. When it did, it left experts in Ohio and elsewhere trying to figure out if President Donald Trump was trying to sabotage the commission’s work, or if it was simply part of his vendetta against Democrats.
    Created in 1914, the FTC is tasked with stopping unfair trade practices — particularly those by big corporations that use their dominance to harm small businesses and consumers.


    Starting around 1980, Republican and then Democratic administrations — which appoint the agency’s commissioners — greatly diminished the role of the FTC and the An rust Division of the Justice Department. The argument then prevailed that despite what the laws themselves said, the goal of an rust law was efficiency, which would supposedly deliver better outcomes for consumers.


    But awareness has grown in recent years that the rise of big box stores, health conglomerates, and tech companies hasn’t been to the uniform benefit of consumers.


    In response, the Biden administration began a new era of stepped-up enforcement of laws that had long been on the books. The FTC filed lawsuits against Amazon, to stop the Kroger-Albertson’s merger, and it sued giant health conglomerates. It accused the latter companies of unfairly driving up insulin prices at the expense of diabetics — especially those with low incomes.
    That was the case that the FTC stayed on Monday.


    The agency did so because two Republican commissioners had recused themselves from the case, saying they had conflicts of interest. A third Republican commissioner hasn’t yet been approved by the Senate. And Trump in March tried to fire the two Democratic appointees, Alvaro Bedoya and Rebecca Kelly Slaughter.


    The case was to be heard by the commissioners. But now there aren’t any to hear it.


    Bedoya and Slaughter are in court challenging the attempted firings, arguing that the president doesn’t have the power to simply decree a change in the structure of a regulatory commission created by Congress. The suit quotes the Federal Trade Commission Act, which says the president can only remove commissioners “for inefficiency, neglect of duty, or malfeasance in office.”


    So long as that lawsuit plays out, the FTC suit against the pharmacy middlemen won’t.


    It alleges that the big three pharmacy middlemen excluded cheaper generic forms of insulin from insurance coverage in order to extract larger rebates from manufacturers’ more costly products.


    The three biggest middlemen, or pharmacy benefit managers, control nearly 80% of the insured drug transactions in the United Sates. Each is a part of a conglomerate that also owns a major insurer — UnitedHealth Group, CVS Health and Cigna-Express Scripts.


    As middlemen, the benefit managers decide which drugs are covered, and which of those have low or no copayments. The FTC suit says that since 2012, they’ve been increasingly aggressive about demanding ever-larger, non-transparent rebates — their critics call them kickbacks — from manufacturers in exchange for covering their drugs.


    With insulin, prices were effectively jacked up when the middlemen refused to cover some of the cheapest alternatives at all, the suit said.
    https://ohiocapitaljournal.com/2025/...-want-to-know/

  3. #203
    dangerous floater Winehole23's Avatar
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    UHC under investigation for Medicare Advantage fraud

    The healthcare-fraud unit of the Justice Department’s criminal division is overseeing the investigation, the people said, and it has been an active probe since at least last summer.
    While the exact nature of the potential criminal allegations against UnitedHealth is unclear, the people said the federal investigation is focusing on the company’s Medicare Advantage business practices….

    The probe adds to a list of government inquiries into the company, including investigations of potential an rust violations and a civil investigation of its Medicare billing practices, including at its doctors offices….

    The Justice Department’s criminal healthcare fraud unit focuses on crimes such as kickbacks that trigger higher Medicare or Medicaid payments….the unit has turned its focus to insurers in the Medicare Advantage system, where they now oversee taxpayer-funded benefits for more than half the seniors and disabled people in the broader Medicare program….

    Medicare Advantage insurers are paid extra for covering sicker patients, creating an incentive to do ent diagnoses for patients they cover. In some cases, the Journal’s reporting has shown, questionable diagnoses by UnitedHealth added billions to taxpayers’ costs….
    https://archive.is/Tsy9z

  4. #204
    dangerous floater Winehole23's Avatar
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  5. #205
    dangerous floater Winehole23's Avatar
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    that's a death panel, right?

  6. #206
    LMAO koriwhat's Avatar
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    Of course you resurrected this thread after downplaying the death of that Jewish couple recently. Go figure I'd find you in here.

  7. #207
    dangerous floater Winehole23's Avatar
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    I've always posted on a wide variety of topics

    It's also my custom to update them

  8. #208
    wrong about pizzagate TSA's Avatar
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    I've always posted on a wide variety of topics

    It's also my custom to update them
    Why did the updates stop on these pet projects of yours?

    Maryland Man
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  9. #209
    Alleged Michigander ChumpDumper's Avatar
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    Why did your updates stop on Comet Ping Pong child sex pizza dungeon?

    QAnon?

    Ukrainum One?

    Cat Stevens?

    Weird art?

    Siiiiiiiiiiiiiiiiiiiiiiiiiiiiiiillllllllllllllllll lllllssssssssssssssssssssssssssssbyyyyyyyyyyyyyyyy yyyyy?

  10. #210
    Independent DMX7's Avatar
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    Looks like him to me

  11. #211
    dangerous floater Winehole23's Avatar
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    Blue Cross ing over cancer docs and hospitals because it can

    • Shortchanged: Blue Cross Louisiana OK’d mastectomies and breast reconstructions for women with cancer but refused to pay a hospital’s full bills. For some claims, it paid nothing.
    • Exceptions: Blue Cross denied payments for thousands of procedures involved in breast reconstruction. But it approved special deals for treatment for executives’ wives.
    • Verdict: A jury found Blue Cross liable for fraud and awarded the hospital $421 million. The insurance company denied wrongdoing and has appealed.
    https://www.propublica.org/article/b...cancer-doctors

  12. #212
    dangerous floater Winehole23's Avatar
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    peer-to-peer consultations often aren't

    insurance companies hire incompetent doctors to deny care




    The doctors reviewing necessity of care for insurance companies rarely are qualified in the specialty for which they are denying care & frequently are working for insurance companies b/c they can no longer practice due to gross incompetence.
    www.propublica.org/article/malp...

  13. #213
    dangerous floater Winehole23's Avatar
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    is this the future of health care?

    The families of two now-deceased former beneficiaries of UnitedHealth have filed a lawsuit against the health care giant, alleging it knowingly used a faulty artificial intelligence algorithm to deny elderly patients coverage for extended care deemed necessary by their doctors.


    The lawsuit, filed last Tuesday in federal court in Minnesota, claims UnitedHealth illegally denied "elderly patients care owed to them under Medicare Advantage Plans" by deploying an AI model known by the company to have a 90% error rate, overriding determinations made by the patients' physicians that the expenses were medically necessary.


    "The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because [UnitedHealth's] AI model 'disagrees' with their real live doctors' determinations," according to the complaint.
    https://www.cbsnews.com/amp/news/uni...urance-denials

  14. #214
    dangerous floater Winehole23's Avatar
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  15. #215
    dangerous floater Winehole23's Avatar
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    DOJ could be compromising its own prosecution by talking Mangione in public, but in fairness the current administration likes to use executive power to propagandize

    https://storage.courtlistener.com/re...40793.53.0.pdf

  16. #216
    dangerous floater Winehole23's Avatar
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    Mangione's lawyers say there was no warrant for the backpack search and no Miranda warning before police questioning

    They contend that the gun and other items should be excluded because police lacked a warrant to search the backpack in which they were found. They also want to suppress some of Mangione’s statements to police, such as allegedly giving a false name, because officers started asking questions before telling him he had a right to remain silent.


    Eliminating the gun and notebook would be critical wins for Mangione’s defence and a major setback for prosecutors, depriving them of a possible murder weapon and evidence they say points to motive.
    https://globalnews.ca/news/11552425/...rian-thompson/

  17. #217
    Garnett > Duncan sickdsm's Avatar
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    I've always posted on a wide variety of topics

    It's also my custom to update them
    Still waiting for the thread about the rampant fraud in the Minnesota Govt. Oh wait, that's a blue state though. Ignore I guess.

  18. #218
    Alleged Michigander ChumpDumper's Avatar
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    Still waiting for the thread about the rampant fraud in the Minnesota Govt. Oh wait, that's a blue state though. Ignore I guess.
    Are you incapable of making a thread?

    I'd be happy to read your objective sources and reply.

    Ignore I guess.

  19. #219
    dangerous floater Winehole23's Avatar
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    Still waiting for the thread about the rampant fraud in the Minnesota Govt. Oh wait, that's a blue state though. Ignore I guess.
    please feel free to create a thread or drop a link if you'd like to reorient the discussion

    you barely had anything to say about Walz and Minnesota

  20. #220
    dangerous floater Winehole23's Avatar
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    , I posted more on this page about Minnesota than you did, sickdsm

    three posts up from yours

  21. #221
    Garnett > Duncan sickdsm's Avatar
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    , I posted more on this page about Minnesota than you did, sickdsm

    three posts up from yours
    Lol, That has nothing to do with the widespread known fraud going on. If it was a red state it would have ten pages of spam posting.

  22. #222
    Garnett > Duncan sickdsm's Avatar
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    Are you incapable of making a thread?

    I'd be happy to read your objective sources and reply.

    Ignore I guess.

    You need to see some sources before you're willing to comment? Are you unaware of that story?

  23. #223
    right about pizzagate Blake's Avatar
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    You need to see some sources before you're willing to comment? Are you unaware of that story?
    It's your claim.

  24. #224
    Alleged Michigander ChumpDumper's Avatar
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    You need to see some sources before you're willing to comment?
    Yes.

    If you're just going to be a whiny chicken , do you really want a conversation with anyone?

    Just post your source, princess.

  25. #225
    dangerous floater Winehole23's Avatar
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    complains about one-sided posting, does nothing to correct the imbalance

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