The Department of Justice questioned former UnitedHealth doctors as it investigates claims that the health insurance giant pushed staffers to make diagnoses that triggered higher Medicare payments, according to a report Wednesday.
The investigation, which dates back to at least last summer, concerns alleged efforts to encourage staffers to record certain diagnoses that trigger higher payments under Medicare Advantage, the program for seniors and the disabled, the Wall Street Journal reported.
Investigators for the Justice Department, FBI, and Health and Human Services Department have been asking for details on patient testing, procedures used to reach certain diagnoses and the process of sending nurses to patients’ homes, according to former UnitedHealth employees.
The Department of Justice did not immediately respond to The Post’s request for comment.
UnitedHealth, whose healthcare executive Brian Thompson was executed by an assassin last year outside a Midtown hotel, said it stands “firmly behind the integrity of our Medicare Advantage business.”
The company added that it welcomes “regular reviews of our policies and practices.”
It took aim at the Journal, which last year reported that members of UnitedHealth plans receive certain lucrative diagnoses at a higher rate than people registered with other Medicare insurers.
UnitedHealth accused the news outlet of “a sustained campaign against Medicare Advantage, relying on incomplete data, a predetermined narrative and a flawed understanding of how the Medicare Advantage program works.”
Dr. Naysha Isom, who worked for a UnitedHealth group near Las Vegas, said Justice Department investigators asked her about special training on making diagnoses, and how the company would contact patients and bring them in to test for lucrative conditions.
“It was really about coding,” Isom told the Journal, referring to diagnosis codes that insurers submit to Medicare to receive payments.
“It was like, what were we asked to do, and how we did it.”
Former UnitedHealth doctor Tom Lin said he spoke to a group of federal prosecutors for about 45 minutes about the company’s diagnosis-recording practices.
“What were some of the common ones? Were you specifically asked to use them? What kind of training have you had on them? Do you feel pressured on using the codes?” Lin told the Journal.
Prosecutors asked about bonuses that doctors were paid for reviewing lists of potential diagnoses suggested by UnitedHealth, Lin said.
Investigators also spoke with a nurse practitioner who previously worked for UnitedHealth’s HouseCalls unit, which sends nurses to the homes of Medicare enrollees and uses software that encourages nurses to document diagnoses, according to the Journal.
The company has argued that its diagnostic practices help detect diseases earlier on.
UnitedHealth on Wednesday said it would “deploy a regular, independent third-party” oversight and audit process for these practices.
The company also noted that a separate decade-long effort from the Justice Department to recover alleged Medicare overpayments did not succeed.
Investigators asked doctors and nurses about several diagnoses, including peripheral artery disease and secondary hyperaldosteronism, as well as a QuantaFlo device used to detect the arterial condition, according to the report.
Doctors and nurses said they were also asked about the “diagnosis cart,” a feature of UnitedHealth’s software that shows potential medical conditions.
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