The Final Boss of Our Medical Misery

A UnitedHealth medical director for utilization management (we’ll call him KW) began to suspect that a popular spine surgeon was misrepresenting patient MRIs to make the case that they needed unnecessary spinal fusion surgery in lieu of a less invasive discectomy procedure.

KW, a board-certified orthopedic surgeon, believed the surgeon was misdiagnosing degenerative disc disease as spondylolisthesis, the rarer condition believed to have afflicted Luigi Mangione , the 26-year-old engineer accused of assassinating UnitedHealthcare CEO Brian Thompson .

"It would be cheaper,” the surgeon reasoned, according to a 2022 lawsuit.

Dr. Durrani 's old malpractice insurer has kept his old patients in agony by refusing to pay out any of the hundreds of millions in jury awards they have won at trial.

As KW ’s lawsuit plainly states, insurers did nothing to stop the surgeon he suspected of misdiagnosing his patients with spondylolisthesis.

The Nixon administration made a decision in the early 1970s after a Nixon aide found himself on a flight next to the intellectual godfather of the “health maintenance organization” a physician policy wonk.

A review of more than a dozen whistleblower lawsuits filed over the past decade against UnitedHealth suggests it has formed mutual relationships with dozens of large physician practices and other provider networks in recent years .

The statute that created Medicare Advantage allowed insurers and providers to “share” in the “cost savings” they recognized by decreasing utilization.