Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage
By Fred Schulte
Kaiser Health News
July 28, 2017
United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges.
The suit, filed by United Healthcare sales agents in Wisconsin, accuses the giant insurer of keeping a “dual set of books” to hide serious complaints about its services and of being “intentionally ineffective” at investigating misconduct by its sales staff. A federal judge unsealed the lawsuit, first filed in October 2016, on Tuesday.
The company knew of accusations that at least one sales agent forged signatures on enrollment forms and had been the subject of dozens of other misconduct complaints, according to the suit. In another case, a sales agent allegedly engaged in a “brazen kickback scheme” in which she promised iPads to people who agreed to sign up and stay with the health plan for six months, according to the suit.
Though it fired the female sales agent, United Healthcare concluded the kickback allegations against her were “inconclusive” and did not report the incident to the Centers for Medicare & Medicaid Services, according to the suit.
Asked for comment on the allegations in the suit, United Healthcare spokesman Matt Burns said: “We reject them.”...
Use Our Content
This KHN story can be republished for free (details).
Showing posts with label secrecy. Show all posts
Showing posts with label secrecy. Show all posts
Friday, July 28, 2017
Tuesday, August 6, 2013
Patient: Kaiser Told Me 'Redheads Bleed More'
This patient was lucky that one person at Kaiser was looking out for her. This surgery might have had an even worse outcome if someone had tried to put her back to sleep when she awoke and saw a problem. I suggest an award for the staff member who insisted, "We can't give her any more medication."
Patient: Kaiser Told Me 'Redheads Bleed More'
(Click link to see documents)
By BARBARA WALLACE
Courthouse News Service
August 05, 2013
ROSEVILLE, Calif. (CN) - Kaiser staff dismissed "blood pouring uncontrollably out of" a woman's hand during surgery and "unbearable" pain afterward by saying "redheads bleed more," she claims in court.
Deborah Kossick woke up during surgery for carpal tunnel syndrome to see "blood pouring uncontrollably out of her hand and extremity, while there was chaos amongst the staff conducting the surgery, one of which kept yelling, 'we can't give her any more medication,'" she says in a complaint filed in Placer County Superior Court.
"Several days after the surgery, plaintiff was in unbearable and uncontrollable pain in her right hand," which was swollen and blackened, the complaint continues. Kossick says she "advised defendants that the pain was unbearable, and she believed that something had gone wrong during the surgery, as there was too much blood. Defendants advised plaintiff that she had nothing to worry about because 'redheads bleed more' than other patients."
At a follow-up appointment with her surgeon, Steven Hatton Ryder, M.D., a month after the operation, Kossick says she complained of continuing pain, swelling and discoloration of her hand. "Defendant showed no sympathy or concern whatsoever, and, instead, told her that there was nothing more he could do for her," the complaint says.
"To this date, plaintiff Deborah Kossick continues to be in an extreme amount of pain in her right hand, which is now permanent. The hand is also swollen and blackened, which will impact her ability to work and care for herself for the remainder of her life," according to the complaint.
Plaintiff seeks general, special and punitive damages, attorney's fees and costs of suit. Her husband, Robert Kossick, sued for loss of consortium. They are represented by David M. Poore of Brown Poore in Walnut Creek, Calif.
Patient: Kaiser Told Me 'Redheads Bleed More'
(Click link to see documents)
By BARBARA WALLACE
Courthouse News Service
August 05, 2013
ROSEVILLE, Calif. (CN) - Kaiser staff dismissed "blood pouring uncontrollably out of" a woman's hand during surgery and "unbearable" pain afterward by saying "redheads bleed more," she claims in court.
Deborah Kossick woke up during surgery for carpal tunnel syndrome to see "blood pouring uncontrollably out of her hand and extremity, while there was chaos amongst the staff conducting the surgery, one of which kept yelling, 'we can't give her any more medication,'" she says in a complaint filed in Placer County Superior Court.
"Several days after the surgery, plaintiff was in unbearable and uncontrollable pain in her right hand," which was swollen and blackened, the complaint continues. Kossick says she "advised defendants that the pain was unbearable, and she believed that something had gone wrong during the surgery, as there was too much blood. Defendants advised plaintiff that she had nothing to worry about because 'redheads bleed more' than other patients."
At a follow-up appointment with her surgeon, Steven Hatton Ryder, M.D., a month after the operation, Kossick says she complained of continuing pain, swelling and discoloration of her hand. "Defendant showed no sympathy or concern whatsoever, and, instead, told her that there was nothing more he could do for her," the complaint says.
"To this date, plaintiff Deborah Kossick continues to be in an extreme amount of pain in her right hand, which is now permanent. The hand is also swollen and blackened, which will impact her ability to work and care for herself for the remainder of her life," according to the complaint.
Plaintiff seeks general, special and punitive damages, attorney's fees and costs of suit. Her husband, Robert Kossick, sued for loss of consortium. They are represented by David M. Poore of Brown Poore in Walnut Creek, Calif.
Subscribe to:
Posts (Atom)