Whistleblower: COVID Cases Inflated for Profit

Oh yes she had ░░░░░░░░ She tested positive for ░░░░░░░░ it but that wasn ░░░░░░░░ her reason for admission ░░░░░░░░ would think that there ░░░░░░░░ a motivation that it ░░░░░░░░ dropped higher higher weights ░░░░░░░░ we are smoke Or ░░░░░░░░ a reimbursement of something ░░░░░░░░ guy went in for ░░░░░░░░ gunshot wounds Np was ░░░░░░░░ as covered and like ░░░░░░░░ would have never known ░░░░░░░░ had covert if he ░░░░░░░░ t gotten gunshot wounds ░░░░░░░░ it s interesting It ░░░░░░░░ the elephant in the ░░░░░░░░ that you re not ░░░░░░░░ to talk about home ░░░░░░░░ is never going to ░░░░░░░░ We don t start ░░░░░░░░ this out Tell us ░░░░░░░░ name your title rework ░░░░░░░░ My name is on ░░░░░░░░ I am a nurse ░░░░░░░░ was a nurse with ░░░░░░░░ healthcare community and state ░░░░░░░░ of rosanna Specifically I ░░░░░░░░ inpatient utilization management coordination ░░░░░░░░ m how long have ░░░░░░░░ done for I ve ░░░░░░░░ for united about seven ░░░░░░░░ about The last two ░░░░░░░░ has when I ve ░░░░░░░░ the inpatient utilization Specifically ░░░░░░░░ brought you here today ░░░░░░░░ come to project Well ░░░░░░░░ ve been seeing some ░░░░░░░░ come over that were ░░░░░░░░ as covered 19 that ░░░░░░░░ felt should not have ░░░░░░░░ coded as covert 19 ░░░░░░░░ ve tried to raise ░░░░░░░░ to my leadership and ░░░░░░░░ with the fraud waste ░░░░░░░░ abuse department and it ░░░░░░░░ kind of fell on ░░░░░░░░ ears And I do ░░░░░░░░ a few patients that ░░░░░░░░ know they went in ░░░░░░░░ reasons outside of a ░░░░░░░░ symptoms but they are ░░░░░░░░ being counted on our ░░░░░░░░ as a covert admission ░░░░░░░░ that may be on ░░░░░░░░ know showing some higher ░░░░░░░░ as well They did ░░░░░░░░ positive for covert but ░░░░░░░░ went in for other ░░░░░░░░ but they are still ░░░░░░░░ counted in our numbers ░░░░░░░░ any questions Get thank ░░░░░░░░ so much on that ░░░░░░░░ great Well that s ░░░░░░░░ You are identified that ░░░░░░░░ were problems and who ░░░░░░░░ you speaking to their ░░░░░░░░ This was our daily ░░░░░░░░ call So it s ░░░░░░░░ of our leadership at ░░░░░░░░ Louisiana health plan and ░░░░░░░░ Wednesday I report off ░░░░░░░░ our covet impatient numbers ░░░░░░░░ can see the trends ░░░░░░░░ we re concerned about ░░░░░░░░ we see the the ░░░░░░░░ and that the peaks ░░░░░░░░ so I try to ░░░░░░░░ why we re having ░░░░░░░░ it s not necessarily ░░░░░░░░ we have patients that ░░░░░░░░ critically ill with kobe ░░░░░░░░ are just the patients ░░░░░░░░ are showing up on ░░░░░░░░ daily census as a ░░░░░░░░ admitting diagnosis of kovac ░░░░░░░░ When did you first ░░░░░░░░ this trend of coding ░░░░░░░░ new patients is scope ░░░░░░░░ some of them are ░░░░░░░░ covered 19 but starting ░░░░░░░░ around March of 20 ░░░░░░░░ one That s when ░░░░░░░░ started really tracking and ░░░░░░░░ focusing on just the ░░░░░░░░ 19 patients and I ░░░░░░░░ say it s around ░░░░░░░░ or July I start ░░░░░░░░ some cases which should ░░░░░░░░ have been covered In ░░░░░░░░ opinion we have a ░░░░░░░░ here over with a ░░░░░░░░ patient Is that ring ░░░░░░░░ bell the one that ░░░░░░░░ got me a while ░░░░░░░░ and I told the ░░░░░░░░ cause on like Oh ░░░░░░░░ god this has nothing ░░░░░░░░ do with covered The ░░░░░░░░ went in for multiple ░░░░░░░░ wounds Np was coded ░░░░░░░░ covet and like he ░░░░░░░░ have never known he ░░░░░░░░ covert if he hadn ░░░░░░░░ gotten gunshot wounds I ░░░░░░░░ we take the cases ░░░░░░░░ they re sent to ░░░░░░░░ but ah I ve ░░░░░░░░ a couple where it ░░░░░░░░ like scheduled vaginal deliveries ░░░░░░░░ The car wrecks you ░░░░░░░░ different things like that ░░░░░░░░ that wasn t the ░░░░░░░░ for going to the ░░░░░░░░ but you know like ░░░░░░░░ said The only way ░░░░░░░░ re going to show ░░░░░░░░ on my senses is ░░░░░░░░ cove it is their ░░░░░░░░ diagnosis Ah I don ░░░░░░░░ wanna say it s ░░░░░░░░ and abuse but I ░░░░░░░░ should I be reporting ░░░░░░░░ like that or just ░░░░░░░░ it go I mean ░░░░░░░░ thing about gazes adnan ░░░░░░░░ people as from work ░░░░░░░░ for call you ve ░░░░░░░░ and name at that ░░░░░░░░ Kinda know who the ░░░░░░░░ A main one I ░░░░░░░░ the sparks and put ░░░░░░░░ That s never what ░░░░░░░░ one code that situation ░░░░░░░░ you speaking to their ░░░░░░░░ is doctor morial she ░░░░░░░░ Actually my boss She ░░░░░░░░ the chief medical officer ░░░░░░░░ united healthcare Louisiana Medicaid ░░░░░░░░ but she also works ░░░░░░░░ a hospital list at ░░░░░░░░ local hospital So she ░░░░░░░░ very familiar she s ░░░░░░░░ on the front line ░░░░░░░░ the whole it and ░░░░░░░░ would you characterize her ░░░░░░░░ I think that she ░░░░░░░░ a little bit surprised ░░░░░░░░ well that her peers ░░░░░░░░ but at the hospitals ░░░░░░░░ doing that You know ░░░░░░░░ she said she wouldn ░░░░░░░░ have done it in ░░░░░░░░ way Fuck quebec 20 ░░░░░░░░ hundred dollar of for ░░░░░░░░ windows of the anybody ░░░░░░░░ people be in charge ░░░░░░░░ indomitable for that earth ░░░░░░░░ if it he came ░░░░░░░░ right The fans are ░░░░░░░░ for it at this ░░░░░░░░ But that may not ░░░░░░░░ what s gonna happen ░░░░░░░░ forward the feds are ░░░░░░░░ for but the supplies ░░░░░░░░ somewhat limited with doctor ░░░░░░░░ is referring to when ░░░░░░░░ feds were paying poor ░░░░░░░░ she talking about I ░░░░░░░░ imagine that it has ░░░░░░░░ do with the cares ░░░░░░░░ and the federal funds ░░░░░░░░ were allocated through the ░░░░░░░░ act do believe There ░░░░░░░░ a financial No incentive ░░░░░░░░ do this I think ░░░░░░░░ there there probably is ░░░░░░░░ I don t see ░░░░░░░░ actual financial side of ░░░░░░░░ but I have heard ░░░░░░░░ rumors You know that ░░░░░░░░ are getting money directly ░░░░░░░░ the federal government for ░░░░░░░░ admissions I wondered what ░░░░░░░░ motivation would be for ░░░░░░░░ because I don t ░░░░░░░░ The reimbursement is gonna ░░░░░░░░ any different Well I ░░░░░░░░ that the reimbursement Um ░░░░░░░░ is quicker right because ░░░░░░░░ all of our cove ░░░░░░░░ it s like a ░░░░░░░░ day turn around for ░░░░░░░░ whereas normally wear like ░░░░░░░░ 30 day reimbursements for ░░░░░░░░ that s maybe that ░░░░░░░░ drive in some of ░░░░░░░░ motivation and I thought ░░░░░░░░ they got reimbursed at ░░░░░░░░ Air rate instead of ░░░░░░░░ rate they do The ░░░░░░░░ Medicare rate would be ░░░░░░░░ higher than Medicaid I ░░░░░░░░ us yeah I would ░░░░░░░░ that this a motivation ░░░░░░░░ it s dropped higher ░░░░░░░░ weights aka Boston But ░░░░░░░░ something Because otherwise is ░░░░░░░░ reason To put something ░░░░░░░░ that is a leading ░░░░░░░░ in a synth the ░░░░░░░░ a symptomatic patients so ░░░░░░░░ when a patient goes ░░░░░░░░ the hospital they at ░░░░░░░░ through utilization review So ░░░░░░░░ have a team of ░░░░░░░░ that review the patient ░░░░░░░░ day We use a ░░░░░░░░ set of criteria auf ░░░░░░░░ all insurance companies use ░░░░░░░░ same set of criteria ░░░░░░░░ we basically are reviewing ░░░░░░░░ and saying the care ░░░░░░░░ this patient is getting ░░░░░░░░ criteria They still need ░░░░░░░░ stay in the hospital ░░░░░░░░ they don t meet ░░░░░░░░ criteria we deny the ░░░░░░░░ or maybe they should ░░░░░░░░ been admitted The first ░░░░░░░░ we re going to ░░░░░░░░ that what happens is ░░░░░░░░ d h which is ░░░░░░░░ Louisiana department of health ░░░░░░░░ hospitals They have suspended ░░░░░░░░ review so they re ░░░░░░░░ telling the insurance companies ░░░░░░░░ they cannot do medical ░░░░░░░░ review We can t ░░░░░░░░ anything when that happens ░░░░░░░░ can see on that ░░░░░░░░ the spikes in numbers ░░░░░░░░ kind of correlate win ░░░░░░░░ d h Suspends utilization ░░░░░░░░ by your critics might ░░░░░░░░ that you re just ░░░░░░░░ that you re just ░░░░░░░░ guessing How will you ░░░░░░░░ to those critics I ░░░░░░░░ say l d h ░░░░░░░░ definitely suspending utilization review ░░░░░░░░ s it s unprecedented ░░░░░░░░ them to do this ░░░░░░░░ are we looking at ░░░░░░░░ This is actually a ░░░░░░░░ plan advisory They have ░░░░░░░░ it multiple times and ░░░░░░░░ is basically telling them ░░░░░░░░ all udall nation management ░░░░░░░░ all medical hospitalizations including ░░░░░░░░ not limited to initial ░░░░░░░░ authorizations and concurrent reviews ░░░░░░░░ be suspended Now this ░░░░░░░░ not specific to cope ░░░░░░░░ my team This is ░░░░░░░░ single hospital admission We ░░░░░░░░ not allowed to do ░░░░░░░░ necessity review so it ░░░░░░░░ the hospitals free rein ░░░░░░░░ admit anything They want ░░░░░░░░ it however they want ░░░░░░░░ the patients and the ░░░░░░░░ as long as they ░░░░░░░░ and we re not ░░░░░░░░ deny anything who was ░░░░░░░░ these directors This is ░░░░░░░░ from l d h ░░░░░░░░ is the Louisiana department ░░░░░░░░ health and hospitals and ░░░░░░░░ ll also point out ░░░░░░░░ that L d h ░░░░░░░░ with all of the ░░░░░░░░ heads the CEOs of ░░░░░░░░ of the hospitals they ░░░░░░░░ once a week with ░░░░░░░░ governor and they discuss ░░░░░░░░ and how they re ░░░░░░░░ go forward Dealing with ░░░░░░░░ coded pandemic cove It ░░░░░░░░ It s interesting because ░░░░░░░░ s the elephant in ░░░░░░░░ room but you re ░░░░░░░░ allowed to talk about ░░░░░░░░ what s your message ░░░░░░░░ the is watching this ░░░░░░░░ betrayed by you Well ░░░░░░░░ mean I hope they ░░░░░░░░ up to the oath ░░░░░░░░ took to do no ░░░░░░░░ to me This is ░░░░░░░░ I don t know ░░░░░░░░ it s illegal because ░░░░░░░░ s being allowed to ░░░░░░░░ by the CDC I ░░░░░░░░ hope They would stand ░░░░░░░░ to their hospital administration ░░░░░░░░ I m sure they ░░░░░░░░ getting pressure from their ░░░░░░░░ to test every one ░░░░░░░░ them multiple times get ░░░░░░░░ cove a diagnosis on ░░░░░░░░ chart but I would ░░░░░░░░ that they would stand ░░░░░░░░ I mean we have ░░░░░░░░ stand up and bite ░░░░░░░░ It s cove It ░░░░░░░░ never going to end ░░░░░░░░ we don t start ░░░░░░░░ this out What we ░░░░░░░░ When our for your ░░░░░░░░ and a is presented ░░░░░░░░ other symptoms aren t ░░░░░░░░ a covert infection even ░░░░░░░░ they may test positive ░░░░░░░░ covert Gosh are primary ░░░░░░░░