UnitedHealth's Medicare Advantage program is under scrutiny following allegations of wrongful coverage denials that have impacted elderly patients like Jackie Martin, an 82-year-old man. Martin fell in his kitchen, fracturing his back, and subsequently faced denied coverage for rehabilitation services from UnitedHealth. Despite appealing and winning twice, UnitedHealth continued to deny him coverage, citing a secret AI algorithm as the basis for their decision.
Martin's son, Robby, has joined a lawsuit against UnitedHealth, claiming the company unjustly withheld care owed to elderly patients under Medicare Advantage. The lawsuit suggests that UnitedHealth prioritized cost-cutting over patient welfare, questioning the ethics of their practices.
“It’s clear that United has no intent to act in the best interest – and best health – of the people they insure,” said Glenn Danas, one of Martin’s lawyers.
The lawsuit has garnered attention from various stakeholders, including a Senate committee investigating the use of prior authorization by Medicare Advantage insurers. This investigation aligns with the Biden administration's view, which has labeled such practices as "inappropriate."
UnitedHealth, however, maintains that their clinical practices align with federal criteria. A spokesperson for the company argued that the Senate committee's investigation "mischaracterizes" Medicare Advantage. The company has yet to respond to specific allegations made by Martin and other plaintiffs.
“This is our process and this is what we do,” stated a manager from a UnitedHealth subsidiary.
UnitedHealth's past coverage denials received renewed focus after the December killing of Brian Thompson, a top executive instrumental in establishing one of its subsidiaries as a key player in the Medicare Advantage market. Now, his son, Robby Thompson, is publicly sharing his family's challenges with UnitedHealth for the first time.
“This is the most frustrating thing that you ever go through. You feel powerless,” expressed Robby Martin.
The lawsuit, led by Clarkson Law Firm and comprising nine plaintiffs including Robby Martin, has yet to see a ruling from the Minnesota US district court on UnitedHealth's motion to dismiss.
“You know, the small person really doesn’t matter to them. They’re a multibillion-dollar company …,” Robby Martin remarked.
The allegations extend beyond Jackie Martin's case. A social worker noted similar experiences with NaviHealth, a UnitedHealth subsidiary.
“Robby … the last six months here NaviHealth has been kicking out all my patients before they’re ready for self-care,” the social worker shared.
The lawsuit argues that UnitedHealth's denials were financially motivated.
“They were just cutting him off because they could cut him off and reduce their expense,” Robby Martin explained.
In addressing these denials, Robby Martin hopes the litigation will prompt a shift in UnitedHealth's practices.
“There has to be some type of moral side to you that says, ‘This needs to be stopped,’” Robby Martin asserted.
Senator Richard Blumenthal emphasized the importance of challenging such denials.
“For Jackie, his family, and the countless other Medicare Advantage enrollees, we must fight denials of post-acute care,” said Senator Richard Blumenthal.
UnitedHealth's subsidiaries, including Optum and NaviHealth, have not commented on the specific allegations made by Martin. Meanwhile, Robby Martin and his legal team continue to advocate for changes in how UnitedHealth handles coverage for its elderly enrollees.
“Plus, they also know that these patients that are 80 years old, that it doesn’t matter if they die,” Robby Martin said.
As the court deliberates on the motion to dismiss, stakeholders await potential precedents set by this case. The outcome could influence broader discussions on health care practices and patient rights within privatized Medicare programs.