When his health plan submits data showing he has diabetes without complications, the payment grows by $1,284, MedPAC wrote in March. Additional coding for vascular disease brings in $3,620 more, raising his total to $11,630. The insurer keeps the money even if the patient isn\u2019t treated for either condition.<\/p>\n
That\u2019s how Medicare Advantage incentivizes insurers to report as many codes as possible.<\/p>\n
Keating, the Boston physician, suspected upcoding in UnitedHealth\u2019s home health assessment of Mrs. G.<\/p>\n
Mrs. G. had been diagnosed by the insurance company\u2019s clinician with chronic pain, morbid obesity and Type 2 diabetes with complications for cataracts and a type of nerve damage called polyneuropathy.<\/p>\n
In Keating\u2019s diagnosis, Mrs. G had a relatively common spinal malady, but without pain. She was obese, but not morbidly so. She did not have cataracts or polyneuropathy. And while testing put Mrs. G in the pre-diabetic range, she did not have diabetes.<\/p>\n
UnitedHealth said it could not respond directly to Keating\u2019s account. But the company said most diagnoses made during in-home visits are not used to generate payments.<\/p>\n","protected":false},"excerpt":{"rendered":"When his health plan submits data showing he has diabetes without complications, the payment grows by $1,284, MedPAC…\n","protected":false},"author":2,"featured_media":170554,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":["post-170553","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-health","tag-health-care","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/170553","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=170553"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/170553\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/170554"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=170553"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=170553"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=170553"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}