A source who works for United Healthcare of Louisiana’s Inpatient Utilization Management Department is blowing the whistle on COVID cases possibly being inflated for financial incentive.
The brazen instance of such potential abuse was a patient who had multiple gunshot wounds with his primary diagnosis listed as COVID.
Here are some of the highlights from today’s video:
- Jeanne Stagg, a whistleblower who worked in Inpatient Utilization Management, approached Project Veritas after seeing cases coded as COVID that she says should not have COVID listed as the “primary diagnosis.”
- Stagg: “I’ve tried to raise awareness to my leadership and even with the Fraud, Waste, and Abuse Department, and it just kind of fell on deaf ears.”
- The Chief Medical Officer for United Healthcare of Louisiana (Medicaid) opined in a recorded phone conversation that the Medicaid rate for reimbursement of COVID patients, which is faster and significantly higher, could be the motivation for the improper “primary diagnosis” codes.
- “Oh, yes. Yeah. I would think that there’s some motivation that it’s driving higher rates of reimbursement or quicker reimbursement, or something, because otherwise there’s no reason to put, you know, something like that as a leading diagnosis in an asymptom– basically asymptomatic patients,” said Dr. Morial, Chief Medical Officer for United Healthcare of Louisiana.
- The Louisiana Department of Health and Hospitals has suspended utilization review which is the process of determining whether health care is medically necessary for a patient or an insured individual. The whistleblower says this could be a major contributing factor to spikes in COVID numbers, which then influence public health decisions.