Their findings have dramatic implications not just for the 15 million people covered by UnitedHealth and other insurance companies we investigated, but for all who age into the Medicare program. At 65, everyone can either pick traditional Medicare or choose a plan offered by a Medicare Advantage insurer. Ross and Herman documented that choosing the latter means you may not receive rehab care when you need it most.
As one example, they chronicled the case of an 85-year-old Wisconsin woman who broke her shoulder in a fall. An algorithm predicted her recovery would take 16.6 days, leading her insurer to cut off payment on day 17, even though she was still maxing out pain scales and could barely push a walker.
Vital watchdog reporting like this has been a hallmark of STAT since we launched in 2015, though it is incredibly challenging and time-consuming. For their series, which has been showered with other top awards in American journalism, Ross and Herman spent years developing the knowledge, sourcing, and expertise needed to understand the complex and proprietary algorithm insurers used to prematurely cut off care, and to uncover flaws in how it was built and is still being used. And just last week, we published the results of a meticulously reported two-year investigation revealing that brain biopsies on "vulnerable" patients at Mount Sinai set off alarm bells at the FDA.
Previously, STAT's Helen Branswell, Andrew Joseph, and the late Sharon Begley were named Pulitzer finalists in breaking news in 2021 "for their prescient, expert and accessible coverage of the emergence of COVID-19, sounding the alarm on the potential spread and potency of the virus." As I write this, Helen and her colleague Megan Molteni are leading the way on coverage of the H5N1 bird flu; we've produced two dozen stories in the past five weeks explaining the science, exploring the safety of milk, and documenting shortcomings in the government response.
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