It’s another chute for UnitedHealth Group, which hardly needs another. On Friday 29 May, the Massachusetts attorney general sued UnitedHealthcare Community Plans of Massachusetts for misrepresenting and manipulating the health records of members in the MassHealth Senior Care Options (SCO) plans. The objective was to gain higher payments from the Commonwealth of Massachusetts. The fraudulent amount in question is about $100 million. The lawsuit was filed in Suffolk Superior Court.
UnitedHealthcare is the largest provider of SCO plans in Massachusetts. SCO is a state Medicaid program that covers members 65 or older who live in designated areas of the state. Based on a mandatory in-home clinical assessment to determine their health status, covered members are assigned a level of care based on health conditions, with Level 1 being the least serious, Level 2 having behavioral health or substance use disorders, and Level 3 having the most serious health conditions. The levels have correspondingly escalating levels of payment to the plan.
The Commonwealth is stating that members were classified by UnitedHealthcare to Level 2 despite no other diagnosis or treatment. Other patients were assigned to Level 3 through improper assessments. Moreover, United allegedly knew that beginning in 2018 and continuing into 2019, members were improperly assigned to Level 3. United never disclosed the error nor repaid the higher payments resulting from the assignment.
From the Office of the Attorney General release, “The AGO alleges that these were intentional failures, the result of a ‘growth at all costs’ strategy employed by United that incentivized and encouraged its field nurses to code MassHealth members as sicker or less able than they were.” UnitedHealthcare responded that the fraud allegations and the lawsuit are “meritless” and that “[The complaint] doesn’t accurately describe our Senior Care Options program, which helps seniors with complex care meet their individual health needs.” MedCityNews, Healthcare Dive
A nice ladder for Teladoc is the addition of their telehealth services to Walmart’s digital health offerings. Walmart’s Better Care Services will add Teladoc’s telehealth services in virtual urgent care for common conditions, dermatology, and nutrition for their customers. Payment can be either cash pay at $89/visit or through insurance. Prescriptions, if needed, can be sent to a pharmacy, including Walmart’s, which has same-day delivery in as fast as an hour available in many locations. Walmart added Teladoc’s BetterHelp mental health services in January. Teladoc release, MedCityNews, Healthcare Dive
And funding ladders continue, indicating some freeing up of investment cash for companies that have gone through a few (or more than a few) rounds.
Glucose monitoring system Signos raised a $20 million round. The investment is from GV (Google Ventures), Dexcom, and Blue Cross Blue Shield of Alabama. Funding to date including this round is $57 million. Signos is also a partner with Dexcom through their direct-to-consumer continuous glucose monitoring website, Stelo.com. Signos’ app for tracking glucose for weight management is FDA-cleared and includes insights into how behavior, lifestyle, sleep, and stress affect weight. It can also detect low and high glucose levels. Membership is $127/month including two sensors a month on the six-month plan. Mobihealthnews, Yahoo Finance
Healthcare provider data and directory company H1 raised $40 million, led by CVS Health Ventures. Across ten lettered and unlettered rounds, funding to date is $233.9 million. It has developed an AI-powered platform for identifying and engaging the right doctor across life sciences, payers, providers, and patients. The H1 Doctor Graph platform is a structured representation of physician identity, expertise, relationships, and behavioral signals that identifies and engages the right doctors for critical workflows across pharma, health plan, health system, and technology companies. CVS Health and H1 have collaborated on several projects, including an AI model that improved the accuracy of their health care provider directory. Release, Mobihealthnews
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