WSJ via MSN: “…Insurer-driven diagnoses by UnitedHealth for diseases that no doctor treated generated $8.7 billion in 2021 payments to the company, the Journal’s analysis showed. UnitedHealth’s net income that year was about $17 billion. UnitedHealth’s Wiggin said the Journal’s calculations appear accurate. He said the added payments are “not simply earnings for the company,” but help pay for medical care, lower premiums and provide other benefits for Medicare Advantage members. Humana disputed the Journal’s calculation that the company had received $2.2 billion in 2021 payments from insurer-driven diagnoses, saying that total didn’t reflect chart reviews that lowered payments by removing diagnoses. Sometimes, insurers didn’t remove potentially outdated diagnoses. The Journal’s analysis found that between 2018 and 2021, nearly 50,000 Medicare Advantage patients completed a course of high-cost drugs that almost always cures hepatitis C, a virus that can cause serious liver damage. Insurers subsequently told Medicare that more than half of the patients who had received the drug treatment still had hepatitis C in a future year, leading to millions of dollars in extra payments. The diagnoses came from the insurers’ chart reviews and assessments, and from physician claims that insurers didn’t correct. “They’re totally wrong,” said Douglas Dieterich, director of the Institute for Liver Medicine at Mount Sinai Health System in New York. “Real world evidence is a 99% cure rate.”… To protect insurers from the risk of winding up with sicker-than-average patients, the government allowed bigger payments for certain serious health conditions. Partly because of that, Medicare Advantage has cost the government an extra $591 billion over the past 18 years, compared with what Medicare would have cost without the help of the private plans, according to a March report by the Medicare Payment Advisory Commission, or MedPAC, a nonpartisan agency that advises Congress. Adjusted for inflation, that amounts to $4,300 per U.S. tax filer. Academic researchers and government investigators have raised questions about high rates of insurer-driven diagnoses in Medicare Advantage. In a 2021 report, the inspector general that oversees Medicare found the agency spent billions of dollars based on insurer-driven diagnoses for which patients received no care from doctors…”