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Stone’s Throw: A Bold New Step in the Sick Care Showdown 

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Hudson Valley area Congressman Pat Ryan, of District 18, is seeking firsthand accounts about Optum’s practices amid mounting complaints.

This is the 19th installment in an investigative column series, launched in December 2022, about CareMount/Optum/UnitedHealth and broader concerns about corporate medical care.

By Adam Stone 

It took just 809 days and approximately a gazillion reported words, but an elected federal leader has finally taken a big, bold, proactive first step toward raising public awareness about how the corporate care crisis I’ve been reporting on since Dec. 10, 2022 has impacted local access to care and treatment.

The news popped yesterday: In response to complaints from Hudson Valley residents about medical care at Optum-owned practices, Congressman Pat Ryan launched a community inquiry to collect firsthand accounts about the impact of corporate ownership on patients.

Representing a district (18) only a touch north of us, the Kingston Democrat – a West Point graduate and former Army intelligence officer – says he has made corporate accountability and health care reform central to his tenure in Congress.

While the survey itself may sound ho-hum, it’s what comes after the public feedback that could prove seriously impactful, especially given the growing awareness across the political spectrum about the disastrous status quo.

The first step should always be winning hearts and minds: Ryan and his office seem to know that.

Since debuting this corporate sick care series in 2022 – you’re reading installment 19 – I’ve asked a lot of local elected officials in our coverage area, Democrats and Republicans, what they plan to do about the mess. 

I never thought to ask Ryan, even though I’ve referenced a few of his constituents in the series, given the fact that Optum Tri-State’s reach stretches up toward Ryan’s neck of the New York woods. 

“My office has been hearing from folks across the Hudson Valley about a decline in care, especially at CareMount Medical and Crystal Run Healthcare, following their purchase by Optum,” Ryan remarked in a press release yesterday, trumpeting his new initiative. “I’m launching this community inquiry to hear from as many folks as possible to directly inform my ongoing oversight.” 

Survey Says

The short, simple and sweet survey – which you can review right here asks people to share feedback on billing issues, care quality reductions, Optum’s general impact on Hudson Valley medical practices, and experiences with appointment access, customer service, and provider changes.

“None of this information will be shared outside of our office without your consent,” the survey reassures participants.

If early response is any indication, the survey has already struck a significant Hudson Valley nerve.

In fact, a spokesperson from Ryan’s office told me that within just two short hours of releasing the survey yesterday afternoon, 200 local responses had already rolled in. 

The substance contained within the replies will help shape the legislative solutions Ryan ultimately champions.

New Measures

To be fair, anecdotal evidence indicates that local Optum in our core coverage area has definitely improved markedly and intentionally since last spring.

A new leadership team, in May of 2024, announced efforts to address patient frustrations by improving phone systems, expanding clinician access, and investing in upgraded facilities and electronic records to enhance care quality and convenience.

“We have been listening to feedback from patients and care teams and are disappointed our operations may have created frustration, including our phone system and wait times to see certain physicians,” a portion of the letter from last spring stated.

I connected with an Optum spokesperson yesterday, who hit upon that broader point of internal efforts to upgrade.

“Since these practices chose to join Optum, we have introduced a number of new measures to continue to enhance our services, including dedicated teams responsible for scheduling and supporting medication refills and clinical questions, as well as technology investments to improve our patients’ experiences,” the spokesperson said in an emailed statement yesterday. “We, too, have felt the impact of the national health care provider shortage and are continuing to invest in solutions to attract, support and retain our dedicated care providers.”

I had asked for local Optum’s reaction to Ryan’s new initiative, and the spokesperson included a constructive nod to the effort in yesterday’s statement. 

“We look forward to meeting with policymakers to discuss the ways in which we can all work together to achieve our common goal of providing the highest quality patient care for individuals and families we are privileged to serve,” the company said. 

That type of reply – acknowledging the broader issues, and seeking solutions – is a far cry from the dismissive communications tone I encountered in 2022 and 2023. 

Give local Optum leaders real credit for trying to change the culture.

But many of the issues are far larger than what can be controlled by the publicly-traded, multinational corporation’s regional officers.

A former Optum doctor I interviewed told me a recent story for a potential future report about the disturbing lengths they said the health care giant goes to manipulate Medicare rules, highlighting a case where a vulnerable, elderly patient was steered into a costly, unnecessary process to allegedly exploit the system. 

‘The Care They Deserve’

Ryan, in his messaging, has presented himself as a pragmatic problem solver since taking congressional office in 2022. 

He touts his focus on health care reform, veterans’ issues, and building bipartisan support with persuasive rhetoric.

“Whether it’s inaccurate billing, new or increased fees, or difficulty getting appointments, it’s unacceptable for any corporation to be driving down quality and driving up costs,” Ryan observed yesterday in his announcement. “I’ll keep pushing to get to the bottom of this and ensure every Hudson Valley family gets the care the deserve.”

He also highlighted what he described as his ongoing efforts to push for lower health care costs, secure funding for expanded services and access, and cited his support for legislation to reduce drug prices and premiums, as well as his co-sponsorship of the Drug Price Transparency in Medicaid Act

Additionally, the congressman pointed to his reintroduction of the Stopping Pharma’s Ripoffs and Drug Savings for All Act, which is designed to “rein in Big Pharma’s current abuse of U.S. patent law, and make it easier to produce less-costly generic drug alternatives,” his announcement said.

I submitted a request for a long-form interview with Ryan on my upcoming podcast Sick Care (a new audio series set to debut in March, produced by award-winning colleagues Sean Cannon, Jane Marie, and Heather Schroering) and his staff said the congressman would appear on the show, when the time is right, after the local survey results are analyzed. 

Inquiring Minds Wants to Know

Ryan’s solicitation for public feedback on the issue comes as Optum’s parent company, UnitedHealth Group, faces federal investigations, including a Department of Justice (DOJ) antitrust review into its aggressive acquisition of physician practices. 

Investigators are reportedly examining whether Optum’s consolidation has harmed patients and independent providers by limiting competition.

Last February, a report I published revealed that UnitedHealth (which operates the world’s largest insurance company) received notice on Oct. 10, 2023 that the DOJ had launched a non-public antitrust investigation into the outfit, according to documents I had obtained.

Insider trading allegations later emerged, based on when top executives dumped more than $120 million in personally-held UnitedHealth shares, aware of the probe while reportedly keeping investors in the dark. 

About a month later, I published a piece featuring whistleblower claims about corporate efforts to manipulate patient diagnoses and increase profits by allegedly misleading the federal government through the Centers for Medicare & Medicaid Services’ (CMS) value-based incentive payments, based partially on internal audio.

Then, in May, I reported for the first time on accounts from insiders about Optum’s initiative to give bonuses to physicians for pushing palliative care and, ultimately, hospice in Massachusetts, and some surrounding states.

‘Manipulating Patients’ Medical Records’

A complaint filed by the California Public Employees’ Retirement System last October seeks class-action status against UnitedHealth for insider trading, fraud, and monopolistic practices, alleging widespread upcoding and Medicare Advantage manipulation, citing this series, Wall Street Journal reporting, STAT News coverage, and plenty of other independent evidence.

Optum has rapidly expanded its footprint nationwide, acquiring medical practices and becoming the largest employer of physicians in the United States, with one in ten doctors reportedly working for the company.

“In the Hudson Valley, concerning reports have emerged that United may be paying its own Optum practices more in order to squeeze local competitors, as well as manipulating patients’ medical records in order to receive higher payments under the Medicare program,” Ryan asserted in his announcement yesterday.

Just last Friday, The Wall Street Journal published a blockbuster new report about the current DOJ initiating a civil fraud investigation into UnitedHealth Groups Medicare billing practices, focusing on diagnoses that led to additional payments to its Medicare Advantage plans.

UnitedHealth strongly denied the allegations.

“The Journal has engaged in a year-long campaign to defend a legacy system that rewards volume over keeping patients healthy and addressing their underlying conditions,” UnitedHealth said in a statement. “Any suggestion that our practices are fraudulent is outrageous and false.”

It will be critical for Ryan and his team to emphasize, from the jump, that the local problems are largely a byproduct of a systemic, nationwide disease, and not unique to our market, or the fault of local managers.

Context Clues

Meanwhile, UnitedHealth Group has leveraged its vast reach – spanning insurance, pharmacy benefit management, data analytics, and medical claims processing – to post an eye-popping $14.4 billion in profits last year. (The $14.4 billion was actually a 36 percent drop from the prior year, partially due to the Change Healthcare cyberattack debacle, ultimately impacting the personal data of 190 million people).

Ryan, in his press release yesterday, also noted how “Optum employees have reported layoffs and chaotic, overburdened work schedules, leading to staff burnout.”

While local care has been far from perfect for more than a minute now, the more severe deterioration started in 2022, after Optum purchased CareMount Medical (the former Mount Kisco Medical Group, MKMG) – a medical group with more than 2,100 providers and 1.6 million patients in the tri-state area, according to statistics Ryan provided. 

The next year, in 2023, Optum acquired Crystal Run Healthcare, with about 400 providers. 

“Patients across the Hudson Valley have reported that the shift to Optum has worsened the quality of their care and reduced access to medical providers in our area,” Ryan said. “This includes difficulty scheduling doctor’s appointments, inaccurate billing, unexplained fees, long wait times, and poor customer service.”

In January of 2023, I obtained Optum’s employment contract with CareMount doctors – the pact included restrictive clauses, including a three-year non-compete that prevented them from practicing within 20 miles of their former offices, with physicians telling me they felt trapped.

The sale to Optum also transitioned our local doctors from shareholders to employees.

While Ryan’s office can’t yet say what the congressman aims to prioritize legislatively, a spokesperson did indicate the plans would result from public input.

What the office does next will “be driven first and foremost by what we hear from our constituents, but everything is on the table,” a spokesperson told me.

“That includes legislation focused on Hudson Valley-specific problems, as well as broader legislation on issues we’re seeing in districts across the country,” the office added.

I sure hope local health care workers – including doctors who have witnessed the realities – empower Ryan’s office with firsthand details.

While there are honest differences of opinion on the treatment, the truth is that any thorough examination of the issues reveals the corporate practice of medicine, as it functions in the United States, to be the root of the disease.

‘Captured by the Corporations’

Ryan’s office should connect with Dr. Mitchell Li, a North Carolina emergency physician and founder of Take Medicine Back.

I interviewed Dr. Li for a piece that was published early last April.

He explained how the Corporate Practice of Medicine doctrine was meant to protect the physician-patient relationship, yet most states’ CPoM bans remain unenforced.

Individual doctors should be enabled to run medicine, not corporate entities.

Physicians must be put back in charge, reclaiming the ethical foundation of their profession and the physician-patient relationship, Dr. Li told me. 

The goal is to expel forces that prioritize profits over patients, undermine trust, create burnout, and leave millions of Americans of all stripes facing financial peril.

“We’re talking about taking the profession of medicine back from the inside,” the doctor said in our interview. “So it’s acknowledging that the profession of medicine has lost its way and lost its ethics. It’s lost its ethical basis. We have essentially let our organizations and our profession become captured by the corporations.”

Mike Check

In our coverage area, it will be worth watching whether our elected federal representatives – newly-minted Congressman George Latimer and second-term Rep. Mike Lawler – prioritize this issue.

While Latimer, a Democrat, might be an easier sell ideologically, it’s Lawler who could be more interesting to keep an eye on here, with Optum in his backyard.

The District 17 Rockland Republican, if he still wants to become governor of New York after voting for massive social safety net cuts this week in the House, could flex his self-described bipartisan muscles by championing the cause. 

When founding Examiner Editor-in-Chief Martin Wilbur and I met with Lawler at his Pearl River office for an in-depth interview in December 2023, the congressman, despite some artful dodging, seemed to possess a genuine understanding of the issues and a real recognition of the nature of the problem in his district and across the country.

​​“So I think from my own experience, and I don’t use Optum, but from my own experience, getting appointments post-COVID is very difficult,” Lawler told us. “In general, I think obviously the health care system has undergone a lot of changes in the last few years, and I think really what you’ve seen is a consolidation into these bigger conglomerates. And while I think there’s certainly some economy-of-scale positives, I think there is some drawbacks on that.”

Best of the West/Best of the East

Some of the change will have to arise outside of legislative chambers, and involve cultural shifts inside of medicine. 

Western doctors, broadly speaking, should do more to promote healthy eating, better sleep, exercise, and stress-reduction techniques like meditation – complementing, rather than mostly relying on, the profitable pills they prescribe.

Japan has the highest life expectancy in the world at around 84.5 years, while the U.S. lags many miles behind at 77.2 years, a stunning statistical gap that seems to at least partially underscore the effectiveness of Japan’s universal health care system, which emphasizes preventive care, cost controls, and broad access.

Thankfully, there’s a growing embrace of scientifically-supported Eastern approaches, whether through reiki, yoga or other healing modalities.

It’s also an interesting moment for the medicinal use of psychedelics, with some in and around Trump’s orbit acknowledging and celebrating their benefits – if administered responsibly with the right mindset and environment.

Those seeking solutions should also read ProPublica’s America’s Mental Barrier coverage, which explores how insurers stand in the way of treatment.

Real Change

Many elected leaders, from both sides of the aisle, whiffed in recent years on an opportunity to take a big swing at this issue.

It was a fat pitch some seemed reluctant to hit.

Ryan’s seemingly thoughtful approach hopefully serves as a valuable reminder of how we should be working to solve problems in this country. 

It’s been revolting to witness – especially among some on the left – the tacit or even explicit approval of the assassination of UnitedHealthcare CEO Brian Thompson, who was murdered in cold blood on Dec. 4 of last year in Midtown Manhattan.

Violence in response to corporate abuse is the worst, most counterproductive, morally reprehensible path.

I’ve been saying for a long while now that we need a local leader – or leaders – to step up and advocate for real change. 

I keep picturing a press conference where Republicans, Democrats, doctors, nurses, patients, caregivers, hospital administrators, mental health professionals, and holistic care advocates stand together to send a powerful message.

Incredibly, it feels like we’re inching closer to that monumental moment.

More to come. 

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