How insurers use doctors to profit off medical codes

Insurers like UnitedHealth are profiting off of the Medicare Advantage system, and it’s causing problems for both doctors and patients.

Traditional Medicare is run by the federal government, while Medicare Advantage health insurance plans are operated by private companies like UnitedHealth. These privately run plans are still subsidized by government funds. Medicare Advantage insurers are paid a set monthly amount for each of their members regardless of whether they received care that month or not. That amount is based on each patient’s personal risk score. The sicker the patient is, the higher their risk score, and the bigger the check insurers receive from the government.

This system is intended to prevent insurers from favoring healthier people over those who have illnesses, but it also leaves room for insurers to make more money by making their patients appear as sick as possible.

This video is part of Health Care's Colossus, a STAT Investigation by Tara Bannow, Bob Herman, Casey Ross, and Lizzy Lawrence. Read it here:

More from STAT:

ABOUT STAT:
Founded in 2015, STAT is a global digital media brand that focuses on delivering fast, deep, and tough-minded journalism about the life sciences industries to over six million monthly site visitors and an additional 20 million readers on the Apple News app. STAT takes you inside academic labs, biotech boardrooms, and political backrooms, casting a critical eye on scientific discoveries, scrutinizing corporate strategies, and chronicling the roiling battles for talent, money, and market share. With an award-winning newsroom, STAT provides indispensable insights and exclusive stories on the technologies, personalities, power brokers, and political forces driving massive changes in the life sciences industry — and a revolution in human health.

[ECUCHRIS]

We are either undercoding or overcoding. It's not intentional. If we had one standard medical record it would help accuracy. Politicians don't care to fix the system because it provides the economy with so many jobs and the government doesn't have to hire people to do this job. Believe me coders are not getting bonuses for upcoding. The insurance companies want to be as accurate as possible but human error in regards to coding will continue to occur unless we have better documentation from the doctors/EHR.