The Dream – "Divided Healthcare"

Host: Jane Marie
Guest: Adam Stone (Reporter, Editor/Owner of Examiner News)
Date: February 7, 2026

Overview

This episode of The Dream relaunches the show’s new weekly interview format, focusing on the continuing series "Sick Care." Host Jane Marie interviews investigative reporter Adam Stone, whose local, boots-on-the-ground journalism in Examiner News has uncovered troubling stories about UnitedHealth, the healthcare giant, and its subsidiary Optum. The episode explores UnitedHealth’s vertical integration, patient experiences, anti-competitive practices, the impact on local healthcare, and the broader implications for the American Dream—especially how consolidation in healthcare can upend local communities and patient care.

Key Discussion Points and Insights

1. UnitedHealth Group's "Behemoth" Status and Vertical Integration

• Context: UnitedHealth is the 7th largest company worldwide, owning insurance, medical providers (Optum), pharmacies, analytics/software, and more.
  • Jane Marie (01:15): "UnitedHealth is the definition of a behemoth and many would say that what it’s doing is probably illegal."
  • Vertical integration: All elements of care—from the doctors, the buildings, to the billing and data—are controlled by the same company.

2. Adam Stone’s Local Reporting as Investigative Entry Point

• Mount Kisco Medical Group Acquisition: Optum purchased this historic group in 2020, and by 2022, local care quickly deteriorated.
• Adam Stone (03:53): "We quickly saw the deterioration of local care... A local resident reached out to encourage us to cover the inability to get anybody on the phone."
• Validation of frustration: Adam’s reporting resonated with the community, transforming private complaints into public discourse.

3. UnitedHealth's National Reach and DOJ Investigation

• Breaking News: Stone uncovered a non-public Department of Justice investigation into UnitedHealth in February 2024.
  • Adam Stone (09:11): "The scoop was just the fact that this inquiry existed that wasn’t public at that time. We published that story... The Wall Street Journal credited our reporting and ran it on their front page the next day. UnitedHealth's stock tanked."
• Expanding Exposure: National stories began to break, with whistleblowers providing more internal details.

4. Upcoding and Fraudulent Medical Billing

• Definition: Upcoding refers to providers using billing codes for more severe/expensive conditions than justified—billing the government for more money.
  • Jane Marie (12:30): "Cook the books."
  • Adam Stone (12:32): "Yeah, right. To basically... I’ll say it."
• Whistleblower Testimony: Ex-Optum nurse practitioner Jason Lohmeyer described being incentivized to confirm diagnoses that padded charts for higher Medicare payouts.
  • Jason Lohmeyer (13:38): "I remember one patient—I took off like 80% of these diagnoses. I'm like, where did they get this from? They have both their legs, they're not a bilateral amputee..."

5. The Human Toll: Patient Stories and Systemic Consequences

a. Medical Record Withholding and Patient Bans

• Rachel Kraus (Katona, NY): After a traumatic stillbirth and complications (2022), was repeatedly denied access to her full medical records.
  • Adam Stone (15:40): "Her and her husband were sent a letter that banned them from care. I didn’t even know…that was a thing you could do."
  • Jane Marie: "What? Is that legal?!"

b. Incentivizing Referrals to Hospice – "Bonuses for Bodies"

• Disturbing Incentives: Optum paid bonuses to encourage moving patients to palliative/hospice care, a practice more about saving costs than compassion.
  • Nurse Practitioner via Stone (17:36): "Bonuses for bodies."
  • Stone (19:45): "With them owning the insurance side and the medical providers... there might be incentives that aren't so obvious."

c. Restrictive Non-Compete Clauses for Doctors

• Mount Kisco Contracts: Doctors were not allowed to practice within 20 miles for 3 years if they left, effectively "trapping" them and reducing options for both doctors and patients.
  • Adam Stone (27:58): "By extension, if you think about it, they're indentured servants."
  • Doctor’s quote read by Stone (28:46): "Now you want to leave but you're trapped. It's wearing people down..."

6. Corporate Practices Impacting Patient Care Access

• Eliminating Open Scheduling: Previously, doctors reserved daily open slots for semi-urgent visits. Optum filled these for guaranteed billables—pushing patients with urgent needs to their own urgent care clinics.

  • Jane Marie (30:23): "The idea that those hours would go untapped was not tolerable to the big bosses apparently and patients were instead encouraged to go to urgent care…but guess who owns the urgent care?"

• Ripple effect: Increased ER use at local, non-Optum hospitals for non-emergencies, straining the broader system.

7. Anti-Competitive Practices and Collusion in Pricing

• The Collusion Game (Sick Care Ep. 4): Matt Lavin, a lawyer, uncovered how insurers and network administrators like Multiplan "collude" to keep out-of-network payments to doctors artificially low, profiting from the difference.
  • Interviewee (25:03): "...they [Multiplan] come up with a price of $100 for that particular service ... United and Multiplan then take in and they share that fee amongst themselves."
  • Jane Marie: "So now you have a $900 gap between the amount the doctor charged and then the amount they were actually paid."

8. The Culture and Fallout of UnitedHealth CEO’s Murder

• National Spotlight: The 2024 murder of CEO Brian Thompson put UnitedHealth in the national conversation.
  • Adam Stone (35:01): "The idea that our culture was gonna be corroded... that violence would inevitably be celebrated, that was my first feeling about it. It quickly became celebrated in mainstream conversation."

Notable Quotes & Segments

• On Monopolistic Reach:

  • "They seem to not just own Boardwalk and Park Place in this industry, but the entire board."
    — Adam Stone (04:53)

• On Upcoding:

  • "It would kind of pre-populate stuff... Whatever was there the year before automatically stayed on the chart... I'm like, where did they get this from? They have both their legs, they're not a bilateral amputee, you know..."
    — Jason Lohmeyer (13:38)

• On Doctor Contracts (Indentured Servitude):

  • "So by extension... they're indentured servants. They can't quit."
    — Adam Stone (27:58–28:00)

• On Patient Bans:

  • "Her and her husband were sent a letter that banned them. Banned them from care. I didn’t even know... that was a thing you could do."
    — Adam Stone (15:40)

• On Hopelessness Doctors Feel:

  • "Now you want to leave but you're trapped. It's wearing people down..."
    — Quoted doctor (28:46)

• On "Bonuses for Bodies":

  • "[It] struck me at the time... bonuses for bodies."
    — Adam Stone (17:36)

Timestamps for Key Segments

• [01:15] – UnitedHealth as vertically integrated "behemoth," introduction to Adam's reporting
• [03:39] – Detailing local care deterioration post-Optum acquisition
• [09:07] – Breaking news of DOJ investigation and national attention
• [11:19] – Explanation and inside view of upcoding (with nurse whistleblower accounts)
• [14:06] – Rachel Kraus’s story and experience of being banned from care
• [17:36] – Inappropriate bonuses for hospice referrals
• [24:14] – "Collusion Game": Multiplan, UnitedHealthcare, out-of-network payment reductions
• [27:01] – Restrictive employment contracts and doctors being "trapped"
• [30:23] – Elimination of open scheduling, increase in urgent care/ER visits
• [35:01] – The cultural aftermath of UnitedHealth CEO's murder
• [37:33] – Discussion of political will and future policy directions in healthcare
• [40:04] – Systemic issue: profits over patients at the root of healthcare dysfunction

Concluding Insights

• Policy Change & Consensus: Stone notes increasing, bipartisan recognition that the status quo in American healthcare is unacceptable—even if solutions remain divisive.
  • Adam Stone (37:50): "Very few people in public life think that the status quo is okay."
• Systemic Rot: The episode stresses how vertical integration, profit-motivated consolidation, and anti-competitive practices are not just abstract business strategies—they play out in the lived experiences of patients, doctors, and entire communities.
  • Adam Stone (41:10): "...it’s essentially impossible to imagine our system delivering humane health care if the central incentive structure is all about profit."
• Human Impact: Doctors feel they can’t serve as they once did; patients are denied crucial care or records; and even negative cultural reactions emerge, such as the public response to the CEO’s assassination.

Listen to more from Adam Stone and "Sick Care" for deeper dives on these stories.
Sources/Supplemental reporting at: examinernews.com
Ad-free versions at: thedream.supercast.com