Note from the ACDIS Director: UnitedHealth Group, Inc. versus the United States of America: The case for CDI

The work of a CDI professional can at times seem isolating and unimportant. Does it matter if a query gets answered? When we educate physicians, and tell them what they document matters, are they listening? Then a case comes along and demonstrates not just that the CDI profession does matter—but that it matters a lot. That point was driven home to me while reading a May 16, 2017 court document, United States of America ex rel. Benjamin Poehling v. UnitedHealth Group, Inc., in which the Department of Justice (DOJ), alleges that UnitedHealth artificially increased Medicare Advantage (MA) reimbursement/Hierarchical Condition Category assignment by mining for non-supported diagnoses that were not documented/reported by the physician or through chart documentation.

This is an excerpt from a members-only article. Please log in or become a member to read the complete article.