<p>美国司法部的刑事医疗欺诈单位已加大对 <strong>联合健康集团</strong>UNH 医疗保险账单做法的调查，重点关注其如何利用医生和护士来增加政府支付。</p>
<p>该调查至少在一年前就已开始，现在随着前员工与联邦调查人员交谈，正受到新的关注。</p>
<p>《华尔街日报》报道，前联合健康员工告诉调查人员，该公司鼓励在患者评估中捕捉某些有利可图的诊断。</p>
<p><strong><em>另请阅读：Humana 支持改革以限制医疗保险优势账单做法</em></strong></p>
<p>这些努力包括对患者进行测试，实施记录医疗状况的协议，以及派遣护士进行家庭评估。</p>
<p>在 5 月，联合健康 reportedly 被司法部调查可能的医疗保险欺诈。该公司随后表示：“我们尚未收到司法部关于今天在《华尔街日报》上报道的所谓刑事调查的通知。”</p>
<p>“我们支持我们的医疗保险优势计划的完整性，” 该公司声明继续说道。调查的一个重点是联合健康的 HouseCalls 部门，该部门派遣护士到医疗保险成员的家中。</p>
<p>护士在这些访问中使用软件，提示他们记录潜在的诊断。调查人员质疑了一位来自该部门的前护士执业者。</p>
<p>他们调查了使用特定工具，例如 QuantaFlo 设备，该设备有助于检测外周动脉疾病，这一诊断在《华尔街日报》的分析中因其频繁使用而被标记。</p>
<p>调查人员还在审查联合健康的内部软件功能，称为 “诊断车”，该功能根据护士的输入显示可能的病症。受到审查的诊断包括外周动脉疾病和继发性醛固酮增多症，这两者都可能导致更高的医疗保险支付。</p>
<p>联合健康表示，其医疗专业人员在分配诊断时应依赖其临床判断。</p>
<p>然而，《华尔街日报》的报道强调，该公司的医疗保险优势成员获得高支付诊断的频率高于竞争计划的成员，这可能导致数十亿美元的额外纳税人资金支付。</p>
<p>在 2019 年至 2021 年间，联合健康每次护士家庭访问基于新诊断获得的额外支付平均为 2,735 美元，约比行业平均水平高出 50%。</p>
<p>仅在 2021 年，该保险公司就收取了 87 亿美元的诊断支付，这些支付没有得到医生或医院的治疗索赔支持，占当年此类支付的近一半。</p>
<p>《华尔街日报》还发现，联合健康医疗实践的医生以异常高的比例分配某些高价值诊断。</p>
<p><strong>Stephen Hemsley</strong>，新任首席执行官，正在站出来承认后果并制定新方向，承诺对公司一些最具争议的做法进行全面审查。</p>
<p>在 7 月，司法部指控超过 320 人，揭露了近 150 亿美元的欺诈索赔，标志着打击医疗欺诈的重要里程碑。</p>
<p>该部门揭示了惊人的 146 亿美元的欺诈索赔。该行动名为 “金矿行动”，还导致查获价值超过 2.45 亿美元的资产，包括现金、豪华车辆和加密货币。</p>
<p><strong>价格动态：</strong> UNH 股票在周三的盘前交易中下跌 1.87%，报 301.94 美元。</p>
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<p><em>图片来源：Piotr Swat via Shutterstock</em></p>

联合健康

<p>美国司法部正在加大对联合健康集团（UnitedHealth Group）医疗保险账单做法的调查，重点关注利用医疗专业人员来提高政府支付的指控。前员工声称，该公司鼓励在患者评估中捕捉有利可图的诊断。调查正在审查联合健康的 HouseCalls 部门及其软件工具，这可能导致数十亿美元的纳税人资金支付过多。在 2021 年，该保险公司因不支持的诊断收到了 87 亿美元。首席执行官 Stephen Hemsley 承诺将对有争议的做法进行审查。在盘前交易中，联合健康的股票下跌 1.87%，报 301.94 美元</p>

<p>The U.S. Department of Justice's (DOJ) criminal healthcare-fraud unit has intensified its investigation into <strong>UnitedHealth Group Inc’s</strong> UNH Medicare billing practices, focusing on how it leveraged doctors and nurses to boost government payments.</p>
<div class="lb-trans"><p>美国司法部的刑事医疗欺诈单位已加大对 <strong>联合健康集团</strong>UNH 医疗保险账单做法的调查，重点关注其如何利用医生和护士来增加政府支付。</p>
</div><p>The probe began at least a year ago and is now drawing fresh scrutiny as former employees speak with federal investigators.</p>
<div class="lb-trans"><p>该调查至少在一年前就已开始，现在随着前员工与联邦调查人员交谈，正受到新的关注。</p>
</div><p>The Wall Street Journal reported that former UnitedHealth employees told investigators that the company encouraged the capture of certain lucrative diagnoses during patient assessments.</p>
<div class="lb-trans"><p>《华尔街日报》报道，前联合健康员工告诉调查人员，该公司鼓励在患者评估中捕捉某些有利可图的诊断。</p>
</div><p><strong><em>Also Read: Humana Backs Reforms To Limit Medicare Advantage Billing Practices</em></strong></p>
<div class="lb-trans"><p><strong><em>另请阅读：Humana 支持改革以限制医疗保险优势账单做法</em></strong></p>
</div><p>These efforts included testing patients, implementing protocols to document medical conditions, and dispatching nurses to conduct in-home evaluations.</p>
<div class="lb-trans"><p>这些努力包括对患者进行测试，实施记录医疗状况的协议，以及派遣护士进行家庭评估。</p>
</div><p>In May, UnitedHealth was reportedly investigated by the DOJ for possible Medicare fraud. The company then said, &#34;We have not been notified by the Department of Justice of the supposed criminal investigation reported, without official attribution, in the <em>Wall Street Journal</em> today.&#34;</p>
<div class="lb-trans"><p>在 5 月，联合健康 reportedly 被司法部调查可能的医疗保险欺诈。该公司随后表示：“我们尚未收到司法部关于今天在《华尔街日报》上报道的所谓刑事调查的通知。”</p>
</div><p>&#34;We stand by the integrity of our Medicare Advantage program,&#34; the company statement continued. One focal point of the investigation is UnitedHealth's HouseCalls unit, which sends nurses to Medicare members' homes.</p>
<div class="lb-trans"><p>“我们支持我们的医疗保险优势计划的完整性，” 该公司声明继续说道。调查的一个重点是联合健康的 HouseCalls 部门，该部门派遣护士到医疗保险成员的家中。</p>
</div><p>Nurses use software that prompts them to record potential diagnoses during these visits. Investigators questioned a former nurse practitioner from the unit.</p>
<div class="lb-trans"><p>护士在这些访问中使用软件，提示他们记录潜在的诊断。调查人员质疑了一位来自该部门的前护士执业者。</p>
</div><p>They probed using specific tools, such as the QuantaFlo device, which helps detect peripheral artery disease, a diagnosis flagged in a Wall Street Journal analysis for its frequent use.</p>
<div class="lb-trans"><p>他们调查了使用特定工具，例如 QuantaFlo 设备，该设备有助于检测外周动脉疾病，这一诊断在《华尔街日报》的分析中因其频繁使用而被标记。</p>
</div><p>Investigators are also reviewing UnitedHealth's internal software feature called the &#34;diagnosis cart,&#34; which displays possible conditions based on the nurse's inputs. Among the diagnoses under scrutiny are peripheral artery disease and secondary hyperaldosteronism, both of which can lead to higher Medicare payments.</p>
<div class="lb-trans"><p>调查人员还在审查联合健康的内部软件功能，称为 “诊断车”，该功能根据护士的输入显示可能的病症。受到审查的诊断包括外周动脉疾病和继发性醛固酮增多症，这两者都可能导致更高的医疗保险支付。</p>
</div><p>UnitedHealth has said that its healthcare professionals are expected to rely on their clinical judgment when assigning diagnoses.</p>
<div class="lb-trans"><p>联合健康表示，其医疗专业人员在分配诊断时应依赖其临床判断。</p>
</div><p>However, the <em>Wall Street Journal’s reporting</em> highlighted that the company's Medicare Advantage members received high-paying diagnoses more often than those enrolled in competing plans, potentially resulting in billions of dollars in extra taxpayer-funded payments.</p>
<div class="lb-trans"><p>然而，《华尔街日报》的报道强调，该公司的医疗保险优势成员获得高支付诊断的频率高于竞争计划的成员，这可能导致数十亿美元的额外纳税人资金支付。</p>
</div><p>Between 2019 and 2021, UnitedHealth received an average of $2,735 in additional payments per nurse home visit based on new diagnoses, roughly 50% more than the industry average.</p>
<div class="lb-trans"><p>在 2019 年至 2021 年间，联合健康每次护士家庭访问基于新诊断获得的额外支付平均为 2,735 美元，约比行业平均水平高出 50%。</p>
</div><p>In 2021 alone, the insurer collected $8.7 billion in payments for diagnoses that were not backed by treatment claims from doctors or hospitals, accounting for nearly half of such payments made that year.</p>
<div class="lb-trans"><p>仅在 2021 年，该保险公司就收取了 87 亿美元的诊断支付，这些支付没有得到医生或医院的治疗索赔支持，占当年此类支付的近一半。</p>
</div><p>The Journal also found that doctors employed by UnitedHealth's medical practices assigned certain high-value diagnoses at abnormally high rates.</p>
<div class="lb-trans"><p>《华尔街日报》还发现，联合健康医疗实践的医生以异常高的比例分配某些高价值诊断。</p>
</div><p><strong>Stephen Hemsley</strong>, recently appointed CEO, is stepping forward to acknowledge the fallout and chart a new course, promising a comprehensive review of some of the company’s most controversial practices.</p>
<div class="lb-trans"><p><strong>Stephen Hemsley</strong>，新任首席执行官，正在站出来承认后果并制定新方向，承诺对公司一些最具争议的做法进行全面审查。</p>
</div><p>In July, the DOJ charged over 320 individuals, uncovering nearly $15 billion in fraudulent claims, marking a significant milestone in the fight against healthcare fraud.</p>
<div class="lb-trans"><p>在 7 月，司法部指控超过 320 人，揭露了近 150 亿美元的欺诈索赔，标志着打击医疗欺诈的重要里程碑。</p>
</div><p>The department revealed a staggering $14.6 billion in fraudulent claims. The operation, named &#34;Operation Gold Rush,&#34; also resulted in the seizure of assets worth over $245 million, including cash, luxury vehicles, and cryptocurrency.</p>
<div class="lb-trans"><p>该部门揭示了惊人的 146 亿美元的欺诈索赔。该行动名为 “金矿行动”，还导致查获价值超过 2.45 亿美元的资产，包括现金、豪华车辆和加密货币。</p>
</div><p><strong>Price Action:</strong> UNH stock is down 1.87% at $301.94 during the premarket session at last check Wednesday.</p>
<div class="lb-trans"><p><strong>价格动态：</strong> UNH 股票在周三的盘前交易中下跌 1.87%，报 301.94 美元。</p>
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</div><p><em>Photo by Piotr Swat via Shutterstock</em></p>
<div class="lb-trans"><p><em>图片来源：Piotr Swat via Shutterstock</em></p>
</div>

联合健康的前员工揭露了医疗保险账单操作中的黑暗秘密