- Jeanne Stagg, a whistleblower who worked in Inpatient Utilization Management, approached Project Veritas after seeing cases coded as COVID-19 that she says should not have COVID-19 listed as the “primary diagnosis.”
- Stagg: “I’ve tried to raise awareness to my leadership and even with the Fraud, Waste, and Abuse Department, and it just kind of fell on deaf ears.”
- The Chief Medical Officer for United Healthcare of Louisiana (Medicaid) opined in a recorded phone conversation that the Medicaid rate for reimbursement of COVID-19 patients, which is faster and significantly higher, could be the motivation for the improper “primary diagnosis” codes.
- “Oh, yes. Yeah. I would think that there’s some motivation that it’s driving higher rates of reimbursement or quicker reimbursement, or something, because otherwise there’s no reason to put, you know, something like that as a leading diagnosis in an asymptom– basically asymptomatic patients,” said Dr. Morial, Chief Medical Officer for United Healthcare of Louisiana.
- The Louisiana Department of Health and Hospitals has suspended utilization review which is the process of determining whether health care is medically necessary for a patient or an insured individual. The whistleblower says this could be a major contributing factor to spikes in COVID numbers, which then influence public health decisions.
[Baton Rouge, La. – Feb. 2, 2022] A source who works for United Healthcare of Louisiana’s Inpatient Utilization Management Department is blowing the whistle on COVID-19 cases possibly being inflated for financial incentive. The brazen instance of such potential abuse was a patient who had multiple gunshot wounds with his primary diagnosis listed as COVID-19.
United Healthcare of Louisiana is the states’ Medicaid arm, and as the whistleblower Jeanne Stagg points out in a conversation with the Chief Medical Officer of United Healthcare of Louisiana, Dr. Julie Morial, there are several financial incentives for hospitals to prefer to code patients as COVID-19 hospitalizations.
“Well maybe that’s… maybe that’s driving some of the motivation,” said Dr. Morial before stating that the Medicaid rate for reimbursement of COVID-19 patients is both higher and faster.
Project Veritas also published footage of a leadership call within United Healthcare of Louisiana wherein the whistleblower’s attempt to discuss the improper primary diagnoses she is seeing was dismissed.
A major element of this story is the fact that recent actions by public officials have allowed the problem to persist, and the whistleblower believes erroneous codes could be the cause of COVID-19 spikes which influence major public health decisions.
A health plan advisory, which announced that all utilization management for all medical hospitalizations [including but not limited to initial service authorization and concurrent reviews], must be suspended was the action taken — which is in question.
“Now, this is not specific to COVID-19. This is every single hospital admission. We’re not allowed to do medical necessity review. So, it gives the hospitals free reign to admit anything they want. Code it however they want,” says the whistleblower, Jeanne Stagg.
United Healthcare of Louisiana’s Dr. Morial was contacted for comment on this story and said, “When I see a patient, and if a patient is presenting other symptoms that aren’t suggestive of a COVID infection, even though they may test positive for COVID, that’s not my primary diagnosis.”