Solidarity HealthShare President Chris Faddis joins The BS Show to talk about how medical coding is contributing to rising costs of healthcare.

Bob Sansevere (00:00):

We are joined by Christopher Faddis, co-founder and president of the nonprofit Healthcare Sharing Ministry Solidarity HealthShare, which is an ethical, affordable alternative to traditional health insurance and is faithful to the moral teachings of the Catholic Church. Chris, I got to talk to you about this because to me, well, I would say it’s stunning, but it really isn’t, and what I’m talking about is what has happened with, well, I’ll read the headline that your Solidarity shared with me. Studies shows how UnitedHealth uses coding to rake in extra cash for Medicare Advantage, and it’s just not extra cash. It’s in the billions. And this is a new study published in the Annals of Internal Medicine. It reveals that major players in the private Medicare space, mainly United Healthcare Group, have been aggressively over diagnosing their members to make them seem sicker to receive more government funding. And nearly 14 billion, that’s 42% of this has gone to United Health, and I mean, people should be in jail or being brought up on charges over this. Do you think that, have you heard anything? Is that going to happen? This is terrible.

Chris Faddis (01:11):

Yeah. Yeah, there’s a lot going on with United right now. I mean, there’s definitely an investigation. They brought in another new CEO, former CEO of United to help clean up the mess. But yeah, it’s really bad, Bob, and this is on top of a lot of other dealings that they have been known to do or be doing that are really questionable. But getting into this payments and doing extra coding, we’ve essentially given a blank check to these insurers that-

Bob Sansevere (01:42):

Get away with it-

Chris Faddis (01:43):

-attach to these Medicare Advantage plans. And this is not just taking advantage of American consumers directly through insurance plans. This is essentially defrauding the federal government in the guise of helping seniors. It’s a really, really bad problem, and I’m hopeful that they are going to face the music on it and not just get embarrassed for a few months and then have a PR campaign to undo it.

Bob Sansevere (02:13):

In the state of Minnesota, there have been several major scandals of fraud that they’ve got money for fraud. I mean, these groups especially was during the covid issue, but nobody is overseeing it and nobody wants to buck the stop with them. Our governors basically disavowed, no one in his administration has paid the price. Now, we basically have a different administration now than when a lot of this was going on. It was under Biden that they got, and I’m not blaming Biden for this, but I mean somebody, it needs to be held accountable, not only at United Health, but also in the federal government for not overseeing this better.

Chris Faddis (02:51):

Right, right. Yeah. And this is, remember we’re talking about United, but it is also Humana and Aetna. I think they comprise a much smaller shares.

Bob Sansevere (03:00):

Yeah, 19 and –

Chris Faddis (03:01):

6% respectfully, percent for Humana, 6% for Aetna. But the same issue of this overcoding, and what they’re doing is they’re using adding certain diagnosis codes that increase reimbursements. And there are several laws on the books that would consider this fraud. And so it’s not just an error. Oopsie, we didn’t know. (No, not an oopsie at all. )I mean, you’re talking 42% of the errors were from United (Stunning) billion. You don’t have a 14 billion rounding error.

Bob Sansevere (03:33):

 No, no. And okay, let me ask this. Is it easier when it involves Medicare than it does other programs? I guess it is, right? They feel the government will just keep writing the check.

Chris Faddis (03:43):

 Yes. Typically it’s because, again, but this is what’s crazy. United is in the business of insurance as well. They have multiple businesses. I mean, this is the reality, right? They own-

Bob Sansevere (03:53):

Yes

Chris Faddis (03:54):

Such a huge market share of the healthcare market, but if you think about it on the other side of their business, they aren’t an insurer. If you and I owned a big hospital system and we were doing this miscoding, they would come after us and try to claw back that money. If we took $14 billion from them by upcoding and adding these fraudulent codes to our bills, United on the insurance side, they would have a department who literally looks for that. And basically what they did is they did the same thing to the federal government through Medicare. And that’s a real problem. It’s also, to me, it’s taking advantage of seniors.

(04:35):

We already know. People are talking about being afraid of Medicare cuts and all these things and wanting to make sure that our seniors are well taken care of. And I think that’s what a lot of people I’ve been hearing in the White House and in Congress are saying is we don’t have to cut necessarily good benefits of Medicare. We need to deal with the fraud and abuse. And if we can do that, just like we’ve talked about with the DOGE thing and all of that, if we can deal with the fraud and abuse, there will be enough money to serve the seniors. But this kind of stuff, to have these corporations taking advantage is just, it’s sickening.

Bob Sansevere (05:11):

And you know what? And it’s not just them because I’ll give you an example of a, this is a doctor I had gone to. He was very good, but basically he was a skin doctor, for lack of a better term. There are better terms, but I’ll go with skin doctor. And every time I would go in, his nurse would walk in with that little canister of where it freezes things on your body.

(05:33):

I don’t know what you call that thing. But anyway, she’d walk in with it and he’d hit me like 10 to 15 times that was not covered by my insurance. This is years ago by my insurance. And I would wind up walking out, spending three to 400 bucks. And then I stopped going to him when I said to him, I had some blackheads under my eye from wearing a C-PAP machine because the oils get trapped. And I said, what are you doing? He goes, well, I’m just spraying it just to be safe. I said, say from what? Well, pre-cancerous. I said, they’re pimples. Do you want me to pop one to show you? And he was very good. Now, a couple of years later, he had a major fine, he was doing something with Medicare that he shouldn’t have been doing, over-billing. And it was not UnitedHealth. It was him, but they never got him on the thing that I was complaining about. So it’s just not UnitedHealth, not every doctor, but there must be incredible amounts of fraud in the medical industry, whether it’s the doctors, the clinics, the hospitals like the United Health, and I don’t know if you could reign them all in, I guess you do what you can, right?

Chris Faddis (06:50):

 Yeah. You got to do what you can. You got to follow the things that are there. I mean, it’s definitely, we deal with this in having to deal with our members’ medical bills. Yeah. I mean, oftentimes you find these upcharges and added charges and double charges and things and thought specifically what’s happening with United. But it’s a real issue. And it definitely, you’re right when you said the end of the day charge at Center for Medicare and Medicaid services need to be on top of this. I mean, it doesn’t matter what administration, these kinds of things are happening and we’ve got to get a handle on it. Which again, I think it’s part of the, was focus of this whole DOGE effect, and I really hope we haven’t lost steam on that.

Bob Sansevere (07:33):

I’m sickened by-

Chris Faddis (07:34):

-With moving away because we need to continue those efforts. It’s incredibly important.

Bob Sansevere (07:41):

Here’s what, it’s sickening to me how people on the other side of the aisle from where Trump is, how they complain about all this stuff because they just here in Minnesota, even the governor, I’m not a huge fan of Tim Walz, but I will say he and the leaders, the Democratic leaders in the House and the Senate, they want to propose because they negotiated with the Republicans and Republicans are in the house here. It’s 67, 67, so nothing gets through from one side. They have to be in agreement. Well, they agreed we’re going to stop giving free healthcare to undocumented people living in the state. Basically illegal aliens and the Democrats, the rank and file Democrats in the House and the Senate are in an uproar about this. And they had tried storming the governor’s office. I mean, I have no problem with that. Take care of our own first, there are people who are American citizens who are struggling with healthcare, but they’re worried about people who are here illegally.

Chris Faddis (08:41):

And you can’t do what you can’t afford. I mean, the reality is that California does not have the access money to do that. I mean, they’re burning what surplus they had.

Bob Sansevere (08:50):

We’re 6 billion in the hole.

Chris Faddis (08:52):

-Infrastructure state. Our real problem,

Bob Sansevere (08:55):

Chris, we’re dealing with it too, we’re 6 billion in the hole, and they’re trying to dig out of that hole. And this is one of the ways to do it, honestly. Yeah, if somebody’s really sick, then these hospitals should pick it up. It shouldn’t be the taxpayers. But I’m going off on a tangent. I want to bring it back to this Solidarity HealthShare, solidarityhealthshare.org. Great alternative to traditional healthcare. And you had mentioned, I mean, one thing you have, and I don’t know if you had it since the beginning, but you have a third party group that negotiates bills that are in dispute. Did you have that at the very beginning or is that something you added?

Chris Faddis (09:28):

We did. It was just a different company. But yeah, we did. (Terrific, though.) We definitely improved it with the current company, and we’re improving it even more. I mean, Bob, we’ve taken a lot of that work in-house, and we’re now between one of the two of us, we’re able to get to the CFOs of a hospital if we have to negotiate a bill.

Bob Sansevere (09:46):

Phenomenal.

Chris Faddis (09:48):

Yeah, it’s been great. And the reality is it’s funny that they’re actually willing to deal, so we’re able to get good rates.

Bob Sansevere (09:55):

Well, I strongly recommend people check out Solidarity HealthShare again, solidarityhealthshare.org. Chris is one of the three co-founders and the president, and I think they do a terrific job, and I’ve been a member for a number of years. Chris, thanks so much. Take a quick break. The BS Show’ll be right back.

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