Posted on 02/08/2022 6:44:41 PM PST by redguyinabluestate
A source who works for United Healthcare of Louisiana’s Inpatient Utilization Management Department is blowing the whistle on COVID-19 cases possibly being inflated for financial incentive. The brazen instance of such potential abuse was a patient who had multiple gunshot wounds with his primary diagnosis listed as COVID-19.
United Healthcare of Louisiana is the states’ Medicaid arm, and as the whistleblower Jeanne Stagg points out in a conversation with the Chief Medical Officer of United Healthcare of Louisiana, Dr. Julie Morial, there are several financial incentives for hospitals to prefer to code patients as COVID-19 hospitalizations.
“Well maybe that’s… maybe that’s driving some of the motivation,” said Dr. Morial before stating that the Medicaid rate for reimbursement of COVID-19 patients is both higher and faster.
Project Veritas also published footage of a leadership call within United Healthcare of Louisiana wherein the whistleblower’s attempt to discuss the improper primary diagnoses she is seeing was dismissed.
A major element of this story is the fact that recent actions by public officials have allowed the problem to persist, and the whistleblower believes erroneous codes could be the cause of COVID-19 spikes which influence major public health decisions.
A health plan advisory, which announced that all utilization management for all medical hospitalizations [including but not limited to initial service authorization and concurrent reviews], must be suspended was the action taken -- which is in question.
“Now, this is not specific to COVID-19. This is every single hospital admission. We’re not allowed to do medical necessity review. So, it gives the hospitals free reign to admit anything they want. Code it however they want,” says the whistleblower, Jeanne Stagg.
United Healthcare of Louisiana’s Dr. Morial was contacted for comment on this story and said, “When I see a patient, and if a patient is presenting other symptoms that aren't suggestive of a COVID infection, even though they may test positive for COVID, that's not my primary diagnosis.”
When the truth gets out you’ll know why Governments wanted to keep going and going
It’s all coming out. Many Hospitals Ceos and Doctors need to be in Gitmo. They are all going down
Before the great Punch magazine became extinct there was a great cartoon. A middle aged woman was talking to another and behind them in the living room was her husband, a stooped over man sitting in an armchair with a blank expression.
“Herman made it through okay with the sex and the drugs but then the rock n’ roll finished him off.”
Now they would have to add the Covid was the end for him.
PING
Gee one would think that would be a crime, like insurance fraud or Medicade fraud at the very least.
What am I saying? That would only be true if it didn’t serve the purposes of the MSM-Democrats. Silly me.
The phoney COVID hospitalizations have been used both to keep the fear going (by the left) and to argue that the vaccines don’t work (by anti-vax Republicans).
I’ve known about this since about March 2020. It was part of the first Covid relief package Pelosi and the Dems pushed through.
This fustercluck has been a scam from Day One.
Are the dead a scam? Me I had this manufactured bat cold and had three days in bed ...beyond that I am fine...NATURAL immunity.
I refused the covid test this Saturday at the ER, and was coded PCR Positive on Sunday.
Pretty sure I had it early on too and survived, even with ‘comorbidities’.
People die from influenza every year - more in some years than others.
However, many MANY more have and will yet die from the communist vermin’s use of the false flag of it as a totalitarian weapon against the people of this nation and nations around the world.
And NONE of the above makes the ChiComs any less than our #1 foreign enemy, with the seditious leftard vermin claiming the #1 spot domestically!
Those that think health care in the US is a free market enterprise are fools...
80% of what you spend on health care in your entire LIFE will be spent, on average, in the last 2 years of your life... and what age are most people in the last 2 years of their life? Old enough to be on medicare.
You don’t increase your profits by providing better service, or by reacting to market forces... the single biggest way to increase your revenues in profit in the US is to figure out how to better code for medicate reimbursement.
I worked for a health care provider, and they increased their revenues annually by 10s of millions of dollars, without changing a single thing in the way they delivered care, or without any increase in patients seen... They did it by creating a system that analyzed the documents created during a patients care, using Natural Language Processing, to scan for terms, codes and phrases that could be used to justify more “accurate” coding to Medicare.
The system would analyze documentation and suggest codes to the coders, and let them look at the document the system found that it though could be used to justify the code. So lets say a document had some term in it that the NLP system thought mapped to a medicare code that wasn’t already set for this submission to medicare, it would suggest the code, show the person doing the coding what document and where in the document it thought was justification for the code... the coder would review the document and then add the code or not after looking at the suggested.
This one thing, one thing, literally earned this system 10’s of millions more dollars every year, without them doing anything else.
MEDICARE and REGULATION drive health care industry, nothing else. And when Medicare does something, they are 70-80% OF ALL PAYMENTS... so when medicare makes a change, you better believe everyone else falls in line with it.
Now, this particular store is FRAUD... my story is not fraud, but just a true assessment of how the US medical system really works from a revenue standpoint. You can’t “fix” it with market forces, because it is NOT driven by them.
for much more see
Robert Yoho’s book
*Butchered By Healthcare*
via a Peter Breggin podcast
Does anyone remember some story early in the pandemic about a guy who was killed by a shotgun blast to the stomach but the cause of death was Covid-19? Then some guy died in a motorcycle crash and was ruled a COVID-19 death.
Upcoding is pervasive in medicine.
We've been had.
Time to end this {censored}, like, yesterday.
We are being buried under non-stop lies. Universal fraud is everywhere.
The reasonable among the population knew this long ago. Now the Bidung administration will redo the numbers to lower them to make him and the left look better. Such a lie.
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