“Things changed after Optum took over.” That was the statement of a case manager with naviHealth, a technology company that used predictive algorithms to manage post-acute care for Medicare Advantage patients. The company sought to limit unnecessary hospital stays and minimize waste, a problem that has plagued the U.S. health care system for decades.
After being sold to Optum, a subsidiary of the health care colossus UnitedHealth Group, naviHealth denied coverage for at least two elderly patients against their doctors’ advice, forcing them to accumulate tens of thousands of dollars in out-of-pocket expenses before they died, according to reporting from STAT News. Employees alleged that UnitedHealth executives pressured them to deny coverage or lose their jobs. The reports most recently led to a class-action lawsuit.