Adam Stone (3:39)

I had been doing a lot of reporting about local health care. Optum had come into one of our home communities, Mount Kisco.

Local Reporter/Colleague (3:53)

In New York.

Adam Stone (3:54)

Yeah, in New York, and acquired a local medical group that was owned by 264 independent doctors previously. It was founded as Mount Kisco Medical Group in 1946, and it had already evolved and changed over the years, like healthcare more generally. But once. So Optum acquired the group in 2020 and then started to make its presence known in 2022. And we quickly saw the deterioration of local care, and there was a local resident who reached out to me to encourage us to cover it. And the specific issue was just the inability to get anybody on the phone. You know, you would call and you couldn't get through to anybody. And so that by itself felt like a significant problem. It's. It's to use a double negative. Not. Not a big deal. To not be able to get somebody on the phone when you're just calling because you're sick or your family member is sick and maybe you're taking a quick break from work and you don't have much time. So it was sort of an entry point into the story. Just this frustration that everybody in town and surrounding towns were feeling and talked about and maybe would gripe about on social media, but hadn't been reported out in a serious way. And I think just validating that frustration in. In print was like, oh, wait, this is actually a real problem. Like, this isn't just standard operating procedure here. This isn't like no big deal. The local newspaper is writing about it maybe. So that sort of started a conversation, sort of like, you know, everybody's had those types of experiences trying to deal with customer service, but now you're trying to talking about it, number one, being a lot worse than the average customer service experience, and number two, with healthcare, which is in a unique category. So in that initial piece, one thing I did pretty intentionally was invite the community to reach out with their feedback. So it sort of became one of those things where one story led to the next story led to the next story and now about three years later it's a 26 part series and now we have this sort of complimentary sick care podcast to go along with it. This was a stat that I heard relatively early on that shocked me that they employ OR affiliate with 10% of U.S. doctors, which I just found pretty shocking by itself. Having grown up playing a lot of monopoly. They seem to not just own Boardwalk and Park Place in this industry, but the entire board. And so the anti competitive monopolistic aspect to the story, while I don't pretend to be a super technical expert, it just seems pretty staggering and obvious and problematic for patients and you know, how it impacts patient care. The story that took the series from a local story as a local newspaper to something that was getting more national attention was in February of 2024. I was speaking to local sources and one conversation led to another and basically obtained some internal communication that confirmed a Department of justice investigation into UnitedHealth. And it was. The interesting thing is reporters sometimes are spoon fed stories with people that have an axe to grind. And this wasn't like that. It was how I ultimately finally got the story was. I mean, not to say people didn't realize what they had, but it sort of came up somewhat circuitously. And then when I got it, it wasn't even presented as something that was like a bombshell necessarily, but it was a non public Department of Justice investigation. And here we are, this small little local community newspaper that's mostly covering, you know, town board, school board, pancake breakfast. Right. So it was just weird to have that information.

Jane Marie (9:07)

Wait, what kind of information is this? If you don't mind contextualizing it?

Adam Stone (9:11)

Yeah, it was the scoop was just the fact that this inquiry existed that wasn't public at that time. So we published that story online and in print and the Wall Street Journal saw that story and then credited our reporting and ran it on their front page the next day. And then UnitedHealth's stock tanked and the story itself got a lot of attention, which then led to sort of more national type leads landing, landing in front of me or sometimes some local reporting that that cropped up as a result of the attention the story was getting nationally. So for example, about a month later in 2024, in March of 2024, I obtained audio of an internal company meeting where sources were characterizing the discussion in that meeting as essentially guiding personnel to upcode, which is ultimately designed to be get more money from the federal government.

Jane Marie (10:34)

Hey, I have a question. Do you have, I mean, is there a place on CMS where we can find what's considered buddy codes, or is this something that y' all have generated up or not all generated up, but yes, we'll get you a list of how they tie together. Okay, thank you.

Local Reporter/Colleague (10:52)

And Optum does use a similar. They don't use the word buddy code.

Adam Stone (10:56)

But they have a different tool which.

Local Reporter/Colleague (10:58)

I can give to Christy to give to you guys, as well as the.

Adam Stone (11:01)

One that I created as well.

Jane Marie (11:02)

So, yeah, send me both, and I'll send them along. Awesome. When you mention upcoding, tell me a little more about what that is and how that could funnel money out of taxpayer dollars, essentially.

Adam Stone (11:19)

Yeah. I mean, upcoding, it's basically like, the way I understand it is a fraudulent medical billing practice where providers use billing codes that are more severe, more complex conditions than what's justified, and then that ultimately allows them to bill the federal government for more money. We spoke to a nurse practitioner, a former nurse practitioner from Optum who worked there for eight years, Jason Lohmeyer, based out of Central Illinois. And he was with their house calls program and house calls provided in home health assessments for Medicare Advantage members. And he was a top performer. He was inside the belly of the beast. But he ultimately learned as the job moved along, I guess you could say that he was really there to. He was ultimately there to.

Jane Marie (12:30)

Cook the books.

Adam Stone (12:32)

Yeah, right. To basically. Right. I'll say it.

Jane Marie (12:35)

You don't have to say it.

Adam Stone (12:36)

I'll say it.

Local Reporter/Colleague (12:38)

And it was about these combination diagnoses. And so if you had a patient with diabetes and they also had cataracts, you could couple those, combine those, and it would be worth a whole lot more. And then the problem is, over the years, there was a push to automate a lot of things. And so you would get done with, like, all of your charting in the computer on the very last page was like, you would confirm what diagnoses you were saying the patient had. It would kind of pre populate stuff based on, like, if you said numbness and tingling and blah, blah, blah in the feet. When you got to the last page, it would say, hey, do you think that's peripheral neuropathy? And you could go, yeah, that sounds right. It's reasonable. Whatever was there the year before automatically stayed on the chart. I remember one patient, I took off, like, 80% of these diagnosis. I'm like, where did they get this from? They have both their legs. They're not a bilateral amputee, you know, so that's what happens when you have these automated pieces, you know, where the computer is taking an assessment, finding, and then generating a diagnosis. And then you're not paying attention on the last page, you're just saying, yep, yep, yep, yep, yep. They have all of this in this.

Adam Stone (14:06)

Ongoing series that I've written. I think the one that hit the human side the best in terms of the human toll, the human impact of profits over patients care was the story of a local woman from Katona named Rachel Kraus. And she was a longtime patient of the local medical group. And she nearly died after a stillbirth, I believe it was, in 2022. And she faced complications from the delivery. And after the traumatic delivery, she attempted to get her full medical records, including ultrasounds and clinical notes, and was repeatedly received with incorrect records despite by, you know, these were lawful requests for her own medical records. And all along it was just causing delays and frustration and she was just dealing with a lot. So just dealing with that headache of not being able to get her records made a very traumatic situation all the more traumatic for her. And ultimately, you know, she was really pushing. And I think there was some heated confrontation in person and whether that was the straw that broke the camel's back. Her and her husband were sent a letter that banned them. Banned them from care. I didn't even know, again, as not a.

Jane Marie (15:40)

What is that legal?

Adam Stone (15:43)

I didn't know it was legal. That's exactly what I was going to say. I didn't know that was even a thing you could do, not only ban her, but her husband, but apparently it's something. I mean, there are some legal gray areas, but for the most part it seemed. I mean, you could make a. A good lawyer could easily make a case that it was legal. But. But I also spoke to an ethicist for this story.

Jane Marie (16:13)

Yeah.

Adam Stone (16:14)

Who got into some of the ethics of it. So although it's murky from a legal standpoint, it's not murky from an ethical standpoint. One story that shocked me was when I heard from a former Optum nurse practitioner who said that the company was paying bonuses that rewarded providers for referring patients into palliative or hospice care. What? Right. Yeah. I was just as stunned as you were. And. Yeah, again, like talking, you know, before you said, I didn't even know that was legal about the patient bans.

Jane Marie (17:17)

Yeah.

Adam Stone (17:17)

I didn't even know there could be bonuses like that in medicine. I didn't know that was a thing. This was. Yeah. So this was a story. And actually, let me. I gotta pull up some different notes if you give me a second.

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Adam Stone (17:36)

The quote that really struck me at the time was when the nurse practitioner characterized it as its bonuses for bodies.

Jane Marie (17:52)

What was the party line in terms of why that was an okay thing?

Adam Stone (17:58)

That's an interesting. That's the subtext of this story from a healthcare standpoint, because they're compassionate people in healthcare. People who are doing healthcare the right way and care about people for the right reasons do believe, including sort of the central sources for this story, that palliative care and hospice care should be embraced and more patients need to know about it, more families need to know about it, more people need to not run away from it. So in theory, you could argue that connecting incentives to that genuine health care goal could be justified. Right? But here it's more a way, based on their description, to, you know, improve the bottom line. I guess one way to look at the motivation from the company side is that when a patient goes into hospice, they usually stop getting expensive hospital care. Fewer ER visits, fewer ICU stays, fewer procedures. And that ultimately saves the insurance company a lot of money. So if you're a company that is in both insurance and healthcare and other aspects of the industry, there might be incentives that aren't so obvious. But looking at the company, more big picture, maybe make some sense so, you know, with them owning the insurance side and the medical providers.

Jane Marie (19:45)

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Adam Stone (23:37)

You Know the insurance arm pays out less while the company can still bill Medicare for hospice care.

Jane Marie (23:44)

More from Adam in just a minute. Welcome back to the Dream. We're talking today with Adam Stone, who has been looking into UnitedHealth and its huge impact on healthcare in America. You can hear a bunch more of his reporting on the podcast we're making together, Sick Care, hosted by Sean Cannon. We've heard so far about how this for profit corporation is negatively impacting patients on the ground, but there's also a bunch going on behind the scenes that could easily go unnoticed by regular Janes.

Adam Stone (24:14)

Our fourth episode in Sick care, it's titled the Collusion Game and it introduces the audience to a lawyer named Matt Lavin. And he's this very, I can say plain spoken but articulate lawyer. And he sort of felt like, to me like a character out of a John Grisham movie from the 90s. And, you know, so he represents doctors and hospitals in lawsuits claiming that organization called Multiplan, which now has a new name and major insurers work together to keep payments for out of network care artificially low.

Jane Marie (24:58)

He said payments to keep payments low, not prices.

Adam Stone (25:03)

So it's about how this small, powerful group of seeming competitors basically work together in this instance to screw over the average person.

Interviewee (possibly a patient or expert) (25:20)

Let's say I go to see a doctor, it's an out of network doctor, I need to see a specialist. And that doctor bills UnitedHealthcare $1,000. United gets that bill, it looks at it, it says this doctor is out of network. And this particular service that he's billing, we're using Multiplan to price that service. They come up with a price of $100 for that particular service. Well, that a hundred dollar price gets transmitted back to United. United pays that hundred dollars to that doctor. And that money comes from my employer to go to the doctor.

Local Reporter/Colleague (25:57)

Okay, so now you have a $900 gap between the amount the doctor charged and then the amount they were actually paid.

Jane Marie (26:05)

That's Sean.

Interviewee (possibly a patient or expert) (26:06)

And what happens and the way that the health insurance companies and the way that Multiplan make their money is they charge the employer plan a fee based on that savings as a percentage of that savings. You know, like 35% say, is the amount. So they're going to charge my employer 35% of 900 for the privilege of underpricing that service. The United and Multiplan then take in and they share that fee amongst themselves.

Local Reporter/Colleague (26:40)

Oh, and then they go to your employer and say, yeah, we're keeping costs down, so pay us for that?

Interviewee (possibly a patient or expert) (26:46)

Absolutely. Meanwhile, my doctor only got paid $100.

Adam Stone (27:01)

Another story that opened my eyes was from pretty early in the series in January of 2023 and I obtained portions of the contract that the doctors had signed. You know, As I mentioned, 264 local independent doctors had sold their shares. You know, they were shareholders in this organization to this company and they signed a non compete contract. And the details of the contract I found at least pretty shocking. So that it stipulates that doctors, if they resign, are barred from practicing medicine within a 20 mile radius of their primary office location for three years. What? So you know, by extension, if you think about it, they're indentured servants.

Jane Marie (27:58)

They can't quit.

Adam Stone (28:00)

Optum's barring area patients from receiving care from their trusted local doctors if they are fed up and want to resign. A lot of these doctors are raising families in the area with kids in local school districts and so forth. So the nature of this contract created a dynamic where these suburban doctors, no matter how frustrated they might be by the new reality of being employed by this company, didn't give them the options to say, limited their options and then by extension limits patient options because the doctors don't have mobility.

Jane Marie (28:43)

It feels very like a trap.

Adam Stone (28:46)

Yeah, I mean that literally in the headline of this story it was examiner probe uncovers quote, restrictive employment contract at Optham Veteran Care Mount. Doctors feel, quote, trapped. Okay, so you just. The word you use, the word that they used. A doctor I spoke to addressed it from a big picture and sort of more specifically about this issue. And the doctor said that the new owner has drastically reduced our salaries. But beyond that he says now you want to leave but you're trapped. It's wearing people down. I love what I do and I have no regrets that I became a physician and chose my specialty. I love taking care of patients and living and working in the community, taking care of friends, friends, parents and the rest of the community. But what we see is the administration running the group poorly and patients continue to complain. Patients tell me one of two things, sorry, I'm not coming to the group anymore. Or they tell me, when are you leaving? I want to go to the next place you're at. But to that last point of I'm frustrated here as a patient, you're frustrated here as a doctor, let's go somewhere else. Because of this non compete contract that was not a practical option for most of these frustrated doctors.

Jane Marie (30:23)

A few more issues that affect everyday people that Adam uncovered and this is my summary, not his. In the pursuit of efficiency, AKA profit. Optum began to get rid of open time slots on primary care doctors schedules. You know that hour or two a day that doctors hold aside, like office hours that are normally reserved for semi emergencies when you wake up with a very sore throat or a UTI and you just want to come in for an antibiotic prescription. Those slots were now being scheduled so they could be, you know, guaranteed billable visits, not held open for last minute patient needs. 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 for these everyday occurrences. But guess who owns the urgent care? Yeah, there is an alternative of sorts.

Adam Stone (31:16)

So we have a separate and actually wonderful local hospital in the area. But because of the frustrations people were having with the phone systems and the deterioration of primary care getting appointments, there was an increase in the use of the emergency room. So it's just to say that there was interconnected nature of how some of these problems tax the system.

Jane Marie (31:50)

Yeah, even systems outside of whatever Optum's up to.

Adam Stone (31:54)

Right, right. So you know, I meet a local trustee at a meeting which I quote in this article says the recent acquisition of caremount Medical by Optum has also left many patients seeking treatment at the Northern Westchester Hospital ER rather than waiting to see their primary care physicians many times for non emergency health issues. So this was part of an update at a local village board meeting. It was just, you know, another example of how patient care was being frustrated by the by all these issues. Yeah.

Jane Marie (32:35)

We'll be right back.

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Adam Stone (32:41)

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Jane Marie (32:49)

Stop.

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Jane Marie (34:46)

You came across my radar and your work through this project that we're working on. But also it became urgent when Brian Thompson, who is the CEO of UnitedHealth, was murdered. Can we talk about that and how that intersected with what you were already working on?

Adam Stone (35:01)

Yeah. So when that news broke, I was in a remote meeting with a couple of our editors and my phone was just beeping and beeping and beeping and I interrupted the meeting to fill them in on the news. And the reason it was exploding on my phone, beyond it just being massive news, was because everybody by this time in the area, sources and readers and so forth, knew I was deep in the local health care story and sort of national healthcare story too. So my phone was just sort of exploding. And you know, we're a local, local newspaper, so normally that wouldn't be a story we would focus on, but we just sort of got to talking about it. But for me personally, I know everybody has different views. I found, and I felt it immediately the moment I heard the, the news. Just, you know, in knowing that it was ideological in nature, I knew that there would be a lot of celebration of the violence. And to me, that felt like literally the worst thing to happen. That given the nature of the story, to see across sort of the political spectrum in some quarters, you know, and it's sort of complex how the politics break down, but just the idea that our, you know, our culture was gonna be corroded even further by the fact that violence would inevitably be celebrated, that was my first feeling about it. And my dominant feeling to this day that it contributed it a big further contributing factor to the corroding of our culture, that it quickly became celebrated in mainstream conversation.

Jane Marie (37:24)

Besides exposing what's going on behind the scenes at these companies, do you feel like there's any policy changes coming up or that you're looking forward to?

Adam Stone (37:33)

I think the thing that has changed, and I'm a very small part of this, is that there's a greater acknowledgement across the political spectrum that the status quo is deeply problematic. Like, you know, just looking at a big picture.

Jane Marie (37:49)

Yeah.

Adam Stone (37:50)

I think that there's not that many people out there anymore who defend the status quo on the right or the left or the middle. And I think that's a little bit of a. Of a change. And one interesting thing in being a local reporter is oftentimes with almost any topic, you'll get, you know, pushback if it's perceived as being sympathetic to one side or another. And I think, because a lot of this reporting over the last three years has been focused on the human toll of local people and their experiences that people themselves have, whether they have an R next to their name or a D or whatever, their personal ideology is that everybody recognizes these problems, has experienced them, or their family has in some way shape or form. And I think my reportings played a small part in helping gain consensus that we might debate the solutions, but we need to prescribe this as that there is a disease and that it needs to be cured, and that very few people in public life think that the status quo is okay.

Jane Marie (39:15)

Doing this reporting can at least get us all aligned on what we don't want to have happen, what we don't want going on behind the scenes.

Adam Stone (39:21)

Right. And I think there are, like, you know, in swing districts in this country, you know, there's not that many swing districts, but there are some. Despite all the gerrymandering of the districts, including in our backyard, there is political pressure on elected officials to address this issue in a way that I think there wasn't in the past. So you see some of that coming up in tight races of the way elected officials who are vulnerable are talking about healthcare.

Jane Marie (40:01)

What do you think the overall problem is that we need to be addressing here?

Adam Stone (40:04)

You know, I'm not. So one problem I have in answering that question is. Cause I think, like, you need, like a professor or like a industry expert to like. So I don't think I'm qualified to give, like, here's the simple solution to a complex problem. What I do think is that health care is a very specific, unique industry, unlike any other industry, if you have to call it that, and it used to be practiced more in the way that was intended. And if you have it sort of getting to your question, that if you have a system that prioritizes profits over patients, it's going to lead to bad outcomes, you know, So I think fundamentally it's essentially impossible to imagine our system delivering humane health care if the central and almost main incentive structure is all about profit.

Jane Marie (41:10)

Right?

Adam Stone (41:11)

One thing I've had to repeat over and over in these articles has been the fact that, you know, although a lot of them are about the impact on patients, the doctors and the nurses and the other healthcare workers in the area are the ones that are the most frustrated, the most angry, you know, and, you know, like in any industry, you're gonna get some bad apples or what have you, but the overwhelming majority got into it for the right reasons, are still in it for the right reasons, but are stuck inside a system where instead of seeing eight patients a day, they need to see 25. Right? And like, no matter, you know, if you're just in that system, no matter how much you know that healthcare, a lot of it is about listening to patients and really hearing them and understanding them, that if you literally don't have the amount of minutes that you're not allowed to have the amount of minutes you need to hear somebody, that's a problem. So I think there's sort of like if you're stuck inside one of these big systems and as a, even as a great doctor, I mean, there's still great healthcare outcomes too. But it seems to happen in spite of the system, not because of it.

Jane Marie (42:37)

Check out sick care wherever you get your podcasts. The Dream is a production of little everywhere. You can find ad free versions of our show@thedream.supercast.com and you can check out Adam's reporting@theexaminernews.com.

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Can we stop at a bathroom?

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Are you alright?

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