E825 | United Health Fraud and What It Means For Cash-Based PT Clinics

UnitedHealth is the largest health insurance, uh, company in the US I believe, on the planet. Right. It is a massive company, huge, huge stock, and one that, uh, is considered one of the sort of blue chip stocks within the Dow Jones, uh, industrial, which is a basket of, uh, big stocks that's tracked. Now I. Why does this matter that, uh, I'm talking about United Health.

Why does it matter that United Health is being criminally investigated, which is a big deal, uh, by the Department of Justice? So here's what's going on. In the last six months, United Health has had a lot of. Bad shit happened. Okay. So their, their CEO was murdered, um, you know, on his way to a meeting. Then the new CEO steps down, and it comes out recently that UnitedHealth is being criminally investigated for Medicare fraud.

Medicare advantage fraud in particular. Right? So I am not a Medicare expert. Um, in fact, in our clinic, uh, we didn't even. Take anybody that was of Medicare age, we didn't accept it. Uh, being a completely cash based clinic just wasn't, uh, our avatar. It wasn't worth it for us to try to, uh, get involved with that or have a hybrid version of that.

Right. But when we look at a big organization like this, that is, I. Enormous and is 50% lower than it was 60 months, uh, six months ago on its stock. That means it is getting absolutely clobbered and not, not that it, it's, the financials are, you know, off by a little bit. It said something is systemically wrong with it.

Now this is something that. Uh, we've known for a long time. Insurance companies suck. In fact, I wrote a whole book about it. It's called Fuck Insurance, and I wrote this, I don't know, years ago. Uh, and it's not necessarily about the insurance company. It's about how you can create a cash based clinic and not have to deal with these assholes, but.

We know they suck and we know that, uh, they're not nice, you know, as far as like wanting to give back to the consumer or whatever. Every year our deductibles go up. Every year our premiums go up and we have less to show for it. We get denied constantly for claims. Like it is, it is not a, a great thing that we have to deal with.

It's not a great thing for our country. Honestly. I think health insurance is probably our biggest problem that we could solve, that could deal with a lot of other financial issues that we have. And when we look at what's happening with Medicare Advantage and UnitedHealth, it's basically this. So Medicare Advantage is, it's privately paid for, essentially by the government to health insurance companies to cover Medicare age individuals.

So Medicare Advantage. Is essentially they're paying a contractor, in this example, UnitedHealth, to take care of, uh, the people that are of Medicare age. Now, it's based on risk factors. So again, this is, I'm gonna dumb this down as much as I can because it is kind of confusing, but essentially the higher your risk is, the more money that the government pays you to have these people that you take care of, um, for their health insurance.

So. What, what UnitedHealth is, um, accused of, and it looks like what they did to the tune of billions of dollars was what's called upcoding. So they basically made people look. More sick than they actually were. So if you can increase somebody's risk level, the government gives you more money because they assume this person's gonna require more healthcare dollars because they're gonna be going to the hospital more.

They're dealing with more, uh, diseases, right? So the, the higher their risk level, the more you upcode that person, the more money the government gives you. Which by the way, where does the government get that money? It gets that money from tax dollars, it gets that money from you and me. So UnitedHealth up codes these people.

Even though they're not as sick as they actually are and the delta, the difference between what they're saying they are and what they actually are turns into net profit for United Health as a company that is what they're being criminally investigated for. They, they've been, uh, civil in a civil lawsuit since last year.

Even for similar practices, and now they've bumped it up to a criminal investigation, which is even more significant. So why do I bring this up, right? Why do I bring this up aside from just a shit on insurance companies again, because they suck. Well, I bring it up because this is just another example of why people are opting out of the system they're opting out of.

Uh, insurance, wanting to use insurance, or even needing to be able to use their insurance. Many people are moving towards catastrophic plans that cover something terrible that happens to them, which hopefully nothing like that does, but if it did, they're covered by, you know, some variation of catastrophic healthcare or very high deductible healthcare.

So what are they looking for with. All of the money that they have to pay to be seen in, in any capacity, right? If you have a, if you have a $10,000 deductible for an individual, right? If you have a $5,000 deductible for an individual, for a family, that might be 10 plus thousand dollars. If you add it all up with different, you know, incidents per person, the total amount that you may have to pay before that is hit for a family could be, you know, five figures.

If you know that and you know you have that much skin in the game, don't you think you're gonna want to be a bit more, uh, informed with your buying decisions of what you're spending that money on and have transparency about what's happening? I mean, how many of you have used your insurance and had no idea what you're gonna owe and you get a bill months later for way more than you were expecting?

Right, and it's because you haven't met your deductible and they're, they're billing you whatever it is, that they would probably bill the, the hospital organization, whatever, but they're not gonna pay them that. Or maybe they, maybe, you know, they will, but you're having to put the bill for that because you haven't met your deductible.

So instead of you going to the dermatologist and paying $450 for a five minute visit with that person, now people are looking for cash-based dermatologist. They'll charge a transparent rate, you know, and, and oftentimes are cheaper, are more time with you, you know, more, less sort of strings attached.

You're not as concerned about, oh, well maybe they're making this decision because of reimbursement or insurance or what they can and can't do. It's very, um, clean it. It's, it's a very like, straightforward relationship. This is something that for me, when I started my first, uh, cash base PT clinic in 2014, I just didn't wanna deal with the headache of insurance.

I didn't wanna deal with having to go into contracts and try to negotiate stuff and billing and all that stuff. And, you know, just thought, okay, cool, it's gonna be a lifestyle business. I'm gonna see a few people during the week and that's it. They're gonna pay me for what I think my time is worth.

Nothing more than that. Well, to, on the negative side, insurance has gotten worse. People like UnitedHealth are committing massive fraud. And you know, the trickle down effect for that is actually a better business scenario, a better business setting for anybody that doesn't wanna take insurance, because lots of people are fed up with it and lots of people are looking for alternatives.

They're also looking for alternatives to sick care. You know, instead of you getting to the point where you're sick and you now have to manage diseases, they're looking for ways in which they can avoid those or limit their likelihood of those as best they can, and they're viewing their health as an investment.

This is a really critical place to be as a business owner with a cash based clinic or a out-of-network clinic or a hybrid clinic or whatever. You want. Some element of where people can have a direct payment option with you so that you can help them achieve their health and wellness goals and be more transparent on the actual insurance side by.

You know, maybe not even taking insurance. So these are matching up really, really well. And if you are getting into a clinic like this right now, and you may be thinking to yourself, and I get this question all the time, is, is it oversaturated? I. Are there too many cash-based clinics? My answer is no. In fact, we're just hitting the upswing of what's gonna happen with this because of shit like this with United Health.

So this is just a massive example of where this is trending and why we really should say buck off insurance. I don't want to take you. I don't wanna have to deal with you, and now you don't have to. As much right now. Maybe you do personally to some degree, but like you don't have to make that your core business model.

We see it trans transitioning this way over and over and over again, and pretty soon examples of this, well, there'll be so many, they'll have to have some sort of massive reform of that, but that could be a long, long time. But for now. All I can say is if you're gonna go the cash or hybrid or out of network route, this is about as a good a time as ever because people are aware of clinics like this.

They're not price sensitive to clinics like this the way they used to be. People used to think I was a jackass because I didn't take insurance when I tried to explain to them. No, the asshole is your insurance company. Like they wanna pay me $75 for a visit with you. How am I supposed to do that and spend an hour with you trying to educate you on how to take care of your body?

I can't do it. And now all these things are converging to where it's gonna increase the likelihood that you can have success in these businesses. And there's gonna be a lot. Bigger pie, I guess is a good way to put it. Of, of what you can share. Even if you think you're started late. 'cause there's thousands of clinics like this, you're not right.

There'll be thousands more in the next few years. It's gonna continue to go that way until there's some sort of massive healthcare reform where people don't have as much direct out of pocket, you know, expenses. And I don't see that happening anytime soon. So if you're looking to start or grow a clinic that is a cash-based clinic or more, uh, cash than insurance and more of a hybrid model.

This is what we do. This is our wheelhouse. We've helped over a thousand clinics do this. Start, grow, scale, sell all across the country for the last seven, eight years, right? This isn't our first rodeo. This isn't something that we just said, you know? You know, it would be, it would be fun to start like an education company for cash based physical therapists.

This is what. Our field is, I started a clinic like this. I've been in the profession of physical therapy. Graduated in 2010. Like this is something that I've seen now transition over the last decade and a half, and it's gone in a direction that is very positive for cash-based clinics, and we're very excited to help them really apply business skills.

To that and actually grow a business and not necessarily just be a great clinician that happened to start a business. 'cause that's not a way to win a business. You've got to improve your business skills if you wanna compete, especially as there's more and more competition for clinics like this. So if you're interested in getting some help, head to physical therapy biz.com.

You don't have to do it by yourself. You didn't go to physical therapy school alone and teach yourself. Why do you think you can start and grow a business by yourself? Like it? It's not as easy as you might think it is. It's very hard, and we can show you exactly how to do it the right way. So thank you so much for watching.

Thanks for listening, and I hope to see you on the next one.