North Carolina State Representative Gregory F. Murphy has raised concerns about UnitedHealthcare’s handling of Medicare Advantage enrollees, claiming that the company alleges these individuals are “55% sicker” to justify charging more to taxpayers. Murphy made this assertion in a post on X dated March 11.
“When you go from traditional Medicare to Medicare Advantage with UnitedHealthcare, you instantly become 55% sicker,” said F. Murphy. “Not really but only so they can charge the American taxpayer more money. United needs to be brought to justice. United needs to be brought to justice.”
According to Murphy, a report from RISE referenced an investigation by the Wall Street Journal that scrutinized the rise in sickness scores among Medicare Advantage patients, particularly those under the care of doctors affiliated with UnitedHealth. The report found an average increase of 30% in sickness scores for all Medicare Advantage plans during a patient’s first year, with UnitedHealth patients experiencing a 55% increase. These adjustments reportedly led to an estimated $4.6 billion in additional Medicare payments to UnitedHealth.
The investigation also examined the role of UnitedHealth’s Optum unit, which employs numerous physicians. It was reported that doctors associated with Optum received software-generated checklists suggesting potential diagnoses before consulting with Medicare Advantage patients. A former physician at UnitedHealth indicated that such checklists were not provided for patients outside the Medicare Advantage system.
UnitedHealth responded by stating that the structure of the Medicare Advantage program is designed to identify and manage health conditions early. The company highlighted that its Medicare Advantage patients had lower rates of hospital admissions and emergency visits compared to traditional Medicare beneficiaries. They also pointed to screening and medication adherence rates as evidence of their patient care approach within the program.
Murphy is currently serving his third term representing North Carolina’s Third Congressional District and is involved in several committees, including the House Ways and Means Committee and the House Veterans Affairs Committee. He co-chairs the House GOP Doctors Caucus and holds degrees from Davidson College and the University of North Carolina’s School of Medicine. He is noted as Congress’s only practicing surgeon.
