Gender Care Docs Threatened; Optum Takeover Regrets; Profiting Off Patients

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Threats Against Docs Treating Trans Minors

Kade Goepferd, MD, of Children’s Minnesota Hospital, has received death threats for their work treating transgender youths, NBC News reported.

Goepferd is hardly alone. NBC News interviewed a dozen clinicians treating transgender minors in states where it’s still legal, and they raised concerns about legal risks and anti-trans attacks. Many said they’ve had to take additional security measures as anti-trans rhetoric has intensified.

One nonprofit director said there has been a “growing awareness over the last year that the environment is only getting more and more dangerous for providers.”

In Georgia, an arsonist destroyed a transgender care clinic, and the incident is being investigated as a hate crime, the outlet reported. The climate of fear has led many clinics to avoid publicity and increase security measures for staff, including removing staff contact information from websites or considering a complete elimination of their online presence.

“It’s emotionally exhausting to be targeted,” Goepferd told NBC News. “It’s also really sad and painful to watch the patients and families that you care for be targeted.”

Practice Gutted After Optum Takeover

Nearly a decade after Optum/UnitedHealth bought Connecticut’s ProHealth Physicians, the primary care network is a “shell of its former self,” STAT reported in its ongoing series on UnitedHealth’s physician empire.

“Doctors are retiring earlier than they planned, or leaving for competing practices,” STAT wrote. “Patients with serious medical conditions struggle to make appointments, while others complain of mysterious diagnoses popping up in their charts. Disillusioned, many patients are leaving.”

“We made a very good living, and we did it by taking the best care of patients and putting our patients’ interests first,” Michael Good, MD, told STAT of the practice he helped establish in Middletown. “We didn’t need to screw people to do that.”

Over the past 20 years, UnitedHealth has brought some 90,000 physicians — or 1 in 10 in the U.S. — under its control, STAT reported. And it has leveraged these physicians, along with its position as the largest Medicare Advantage insurer, to maximize profits, the outlet added.

After speaking with more than 15 former doctors, current and former ProHealth patients, and experts in corporate medicine, and reviewing documents obtained through public records requests, STAT reported that what has happened at ProHealth is “much the same as described by former doctors at five other primary care practices UnitedHealth has purchased around the country.”

The company’s “creeping influence morphed into a full takeover,” in the wake of the pandemic, STAT reported. Corporate managers pushed doctors to add diagnoses to medical records that would make patients look sicker and justify higher payments from Medicare, the outlet added. And doctors’ concerns were “met with skepticism, condescension, and even retaliation,” it continued.

UnitedHealth declined to make executives available to STAT for interviews, and did not answer a list of questions from the outlet on the record. Spokesperson Eric Hausman told STAT that the company’s providers make independent clinical decisions.

Psychiatric Patients Held for Profits?

Acadia Healthcare, which operates more than 50 psychiatric hospitals nationwide, has seen its revenue soar and stock price more than double in the wake of a pandemic that exacerbated a mental health crisis, the New York Times reported. However, patients there have often been held for financial reasons instead of medical ones, more than 50 current and former executives and staff members told the outlet.

In at least 12 of 19 states in which Acadia — valued at about $7 billion — operates psychiatric hospitals, dozens of patients, employees, and police officers have alerted authorities that it has detained people in ways that have violated the law, the Times reported, citing records it reviewed. In some cases, judges have intervened to make Acadia release patients.

Instances of patients being held have included a social worker, who spent 6 days at an Acadia hospital in Florida after she attempted to get her bipolar medications adjusted, and a children’s hospital employee, who spent 7 days at an Acadia facility in Indiana after seeking therapy, among others, the Times reported.

“Acadia held all of them under laws meant for people who pose an imminent threat to themselves or others,” the Times wrote. “But none of the patients appeared to have met that legal standard, according to records and interviews.”

Meanwhile, Acadia charges $2,200 a day for some patients, the Times reported. And at times, it uses strategies designed to convince insurers to cover longer stays, employees told the outlet. These have included exaggerating patient symptoms, tweaking medication dosages, and arguing patients are not well enough to leave due to not finishing a meal.

Tim Blair, a spokesperson for Acadia, declined to comment on individual patients, citing privacy laws, according to the Times. However, he said patient examples cited by the outlet were not representative of many patients who have had positive experiences.

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