STAT Investigation: How UnitedHealth pressured doctors on diagnoses

Plus: What worries FDA chief Robert Califf

October 16, 2024 Check out STAT+

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By Theresa Gaffney Morning Rounds Writer and Podcast Producer

Good morning! My editor said that the uncertainty in my write-up below on Helen's story ("Is it time to freak out about bird flu?") reminded her of this iconic moment from NBC's "30 Rock." Perhaps too real to be funny? What do you think? See you at the Summit later!

stat investigation Money, peer pressure, and guilt: How UnitedHealth pushed doctors to diagnose more Medicare patients In late 2020, an email from a UnitedHealth Group manager detailed the "#1 PRIORITY" for one practice. The goal was for doctors to document older patients' chronic illnesses to generate more revenue from the federal government. As an incentive for seeing more patients, emails promised "ADDITIONAL BONUSES!!" Also, receiving a "SHOUT OUT!!"  The latest investigation in the STAT Health Care's Colossus series exposes UnitedHealth's corporate strategy to enlist its doctors to pile money-making diagnoses onto patients covered by Medicare Advantage, the federal health care program for older adults that's run by private insurers. Since the government pays insurers more for sicker patients — a system known as risk adjustment — the company uses its unrivaled control over its doctors to make those patients look as sick as possible on paper.  "Effectively what you're incentivizing is sicker patients, or at least sicker appearing on paper, which I think is a joke," said Nick Jones, a doctor who used to work at a UnitedHealth practice. Read more from my amazing colleagues Tara Bannow, Bob Herman, Casey Ross, and Lizzy Lawrence. all stars It's the most Wunderkind time of the year Every year, STAT puts on a search for North America's best early-career researchers in health and medicine. They're postdoctoral fellows, medical trainees, and industree scientists. Today, we'd like to introduce you to this year's class of Wunderkinds. Below are just a few of these fantastic folks: Divya Jain is a bioengineer who studies head trauma. Like many people, she started in the world of sports and recreation medicine. But she soon realized that there are a lot of ways people can get injured that have nothing to do with sports — and often don't get nearly as much attention. Now, she's focused on the brain and behavioral effects of head trauma from intimate partner violence.  WWE wrestler Dave Bautista is not a STAT Wunderkind, but he did inspire one. Ramisa Fariha grew up in Bangladesh, watching wrestling with her brother. After reading Bautista's memoir in seventh grade, in which he wrote about his ex-wife's struggle with ovarian cancer, she decided she wanted to become a scientist. Now, she studies stem cell growth, breast cancer tissue imaging, liquid chromatography mass spectrometry methods, and more.  Alexander Chern was just a child when he was diagnosed with congenital hearing loss. His mother signed him up for violin lessons, with the hope that it could help his hearing. Years later, Chern was a medical student at Vanderbilt University when he got hit by a car going 50 miles per hour, putting him in a two-week coma. The long recovery process gave him needed time to reconsider his life and its path — and to listen to the classical music he grew up playing and listening to. Now, his research revolves around the way music might affect a person's health and behavior. He's trying to see if his mother was right. Read more about all the Wunderkinds. cardiovascular health Q&A: What worries FDA chief Robert Califf Robert Califf, a cardiologist and commissioner of the FDA, has been deeply involved in cardiovascular research over the course of his career. But in a conversation with STAT's Liz Cooney, he invoked his role as a grandfather to explain his thoughts on how ultra-processed foods impact health. "I have this recurrent thought that my great-grandkids will read that there was once a country called the U.S.A. where we used overwhelming manipulation of food and advertising to create an enormously obese population. And our solution to it was to invent a class of drugs that cost $20,000 a year to try to counteract it," he told Liz. "And they would say, 'What kind of country is that?'"  Read the conversation. And don't miss the first two stories in this special report from Liz on a crisis in primary care and why the U.S. isn't doing better in the battle against cardiovascular disease.

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infectious disease Is it time to freak out about bird flu? Christine Kao/STAT  If you've been reading media coverage of the whole bird-flu-in-cows situation across the U.S., you may have noticed a wide spectrum of urgency or panic in the tone of experts quoted. Some are clearly on edge, while others may want to play things down. So what's the truth? The truth, as STAT's Helen Branswell explains it, is that when it comes to this virus, we're in scientific limbo. There's currently no way of knowing all the changes H5N1 would need to undergo to trigger a pandemic, or whether it is capable of making that leap.  Helen has been covering H5N1 for two decades. "I've done plenty of worrying about it over the intervening years," she writes. "I no longer assume every unwelcome thing the virus does means we're on the precipice of a pandemic. Still, I have never felt that this virus is something I can safely cross off my things-to-watch-closely list." Read more for Helen's measured, informed, illuminating take. one big number $18 million That's how much pharmaceutical company Sanofi is donating to three historically Black medical schools to support work increasing diversity in clinical trials, per an announcement today. The three institutions — Howard University College of Medicine, Meharry Medical College, and Morehouse School of Medicine — will use the funds to hire research staff, create training programs, and build services like online chat features and pharmacy upgrades. A representative from Sanofi told STAT that the company is not disclosing the specific allocation to each institution at this time. Read some of STAT's coverage on diversity in clinical trials, including a special series by STAT's Angus Chen on diversity in cancer trials. And if you haven't already, listen back to the "Color Code" podcast. We have one episode on why the U.S. is falling short on diversity in trials, and another on the 1910 Flexner Report that closed five out of seven historically Black medical schools.  big names Listen: Mark Cuban has no doubt he can disrupt health care Mark Cuban came on the "First Opinion Podcast" this week to talk with STAT's Torie Bosch and Matthew Herper about pharmacy benefit managers, the 2024 presidential campaign, and how the health care industry should work. Health care "is literally the easiest industry to interrupt, to disintermediate, that I've ever been involved with," Cuban said. Cuban also explained his rationale for backing Harris over Trump when it comes to pharmaceutical reforms. "I don't think she's as transactional" as former President Donald Trump, he said. Listen to the podcast wherever you get your podcasts, or right on the STAT site.

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Thanks for reading! More tomorrow,

theresa.gaffney@statnews.com

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