It’s no coincidence that the business model behind the recent revelations of UnitedHealth Group defrauding Medicare is eerily familiar. They have managed to combine the toxic demand to succeed at all costs found at Wells Fargo with the heartless teachings of shareholder over stakeholders from the Harvard Business School. Meanwhile, Republicans in Congress look to gut the Affordable Care Act citing increased costs, never realizing what is contributing to those rising prices. There’s just one word for that—sick.
Benjamin Poehling, the former finance director at UnitedHealth, alerted the Justice Department to this when he realized that billions of taxpayer dollars have been stolen by big insurance companies that have been bilking the system. Now the Justice Department is suing his former employer, UnitedHealth Group, and plans to investigate other companies who are also Medicare Advantage participants.
Medicare Advantage, which is the program that’s been swindled, was supposed to be the solution to the $13 trillion funding gap in Medicare. It was instituted by Congress to fix the gap by turning it over to the insurance companies with the expectation that they provide better care for a lower price. At this point the only ones benefiting are the insurance companies. According to the New York Times, UnitedHealth has reaped some $3 billion in profit over five years from Medicare Advantage. We still don’t know how much other insurance companies may have stolen.
As in all of these whistleblower cases, this puts employees in a terrible position. Comply and you become a crook and if caught, will be fired and possibly prosecuted. Refuse to comply and you’ll be fired. Become a whistleblower and risk your career and possibly your health and well-being. You’d think an insurance company would recognize behavior that puts people at risk.