Insurers Pocketed $50B from Medicare for Diseases No Doctor Treated

  The insurers make new diagnoses after reviewing medical charts, sometimes using artificial intelligence, and sending nurses to visit patients in their homes. They pay doctors for access to patient records, and reward patients who agree to home visits with gift cards and other financial benefits.

  Insurers added diabetic cataract diagnoses to 148 patients treated by Dr. Howard Chen, an ophthalmologist in Goodyear, Ariz. He said he saw at most one or two such cases a year.

  He said he charges insurers $40 per patient to cover his costs for providing them with medical charts.

  “If they are just making stuff up, then why do they even need or want my charts?” said Chen.