Jessica Mendoza

Because diabetic cataracts are a costly condition, they come with a big payment, one that added up over time. During the three-year period that Chris looked at, the government paid insurers more than $700 million just for recording diabetic cataracts, even if no doctor provided any treatment. And Medicare Advantage ensures diagnosed all sorts of diseases that were never treated.

Like peripheral artery disease. It's a serious condition where blood vessels get narrower, and in some cases, it can lead to amputations. A House Calls training manual reviewed by the investigations team advised nurse practitioners like Kristen to diagnose peripheral artery disease based on results from a device called the Quantiflow.

Like peripheral artery disease. It's a serious condition where blood vessels get narrower, and in some cases, it can lead to amputations. A House Calls training manual reviewed by the investigations team advised nurse practitioners like Kristen to diagnose peripheral artery disease based on results from a device called the Quantiflow.

Like peripheral artery disease. It's a serious condition where blood vessels get narrower, and in some cases, it can lead to amputations. A House Calls training manual reviewed by the investigations team advised nurse practitioners like Kristen to diagnose peripheral artery disease based on results from a device called the Quantiflow.

If the quanta flow showed decreased blood flow, Kristen was supposed to conclude that the patient had peripheral artery disease. But she says she was uncomfortable making such a definitive diagnosis just based on the device, especially since elderly people often have decreased blood flow.

If the quanta flow showed decreased blood flow, Kristen was supposed to conclude that the patient had peripheral artery disease. But she says she was uncomfortable making such a definitive diagnosis just based on the device, especially since elderly people often have decreased blood flow.

If the quanta flow showed decreased blood flow, Kristen was supposed to conclude that the patient had peripheral artery disease. But she says she was uncomfortable making such a definitive diagnosis just based on the device, especially since elderly people often have decreased blood flow.

But the quanta flow had problems. Here's Chris again.

But the quanta flow had problems. Here's Chris again.

But the quanta flow had problems. Here's Chris again.

The maker of Quantiflow, Semler Scientific, said the device assesses risk for the disease. UnitedHealth told us that it tests for the disease during home visits to diagnose it early, and that it expected clinicians to use their judgment.

The maker of Quantiflow, Semler Scientific, said the device assesses risk for the disease. UnitedHealth told us that it tests for the disease during home visits to diagnose it early, and that it expected clinicians to use their judgment.

The maker of Quantiflow, Semler Scientific, said the device assesses risk for the disease. UnitedHealth told us that it tests for the disease during home visits to diagnose it early, and that it expected clinicians to use their judgment.

According to the journal's reporting, those peripheral artery disease diagnoses led to nearly $1.4 billion in additional payments to UnitedHealth between 2019 and 2021. Semler Scientific was also under investigation by the Justice Department for potential fraud. The company announced in May it had reached a tentative agreement to settle the case for nearly $30 million.

According to the journal's reporting, those peripheral artery disease diagnoses led to nearly $1.4 billion in additional payments to UnitedHealth between 2019 and 2021. Semler Scientific was also under investigation by the Justice Department for potential fraud. The company announced in May it had reached a tentative agreement to settle the case for nearly $30 million.

According to the journal's reporting, those peripheral artery disease diagnoses led to nearly $1.4 billion in additional payments to UnitedHealth between 2019 and 2021. Semler Scientific was also under investigation by the Justice Department for potential fraud. The company announced in May it had reached a tentative agreement to settle the case for nearly $30 million.

The company did not respond to requests for comment about the investigation. Those questionable diagnoses weren't just for rare diseases like diabetic cataracts or peripheral artery disease. They were also for HIV, the virus that causes AIDS. During a four-year period, thousands of Medicare Advantage recipients had diagnoses of HIV added to their records by their insurance companies.

The company did not respond to requests for comment about the investigation. Those questionable diagnoses weren't just for rare diseases like diabetic cataracts or peripheral artery disease. They were also for HIV, the virus that causes AIDS. During a four-year period, thousands of Medicare Advantage recipients had diagnoses of HIV added to their records by their insurance companies.

The company did not respond to requests for comment about the investigation. Those questionable diagnoses weren't just for rare diseases like diabetic cataracts or peripheral artery disease. They were also for HIV, the virus that causes AIDS. During a four-year period, thousands of Medicare Advantage recipients had diagnoses of HIV added to their records by their insurance companies.

For each of these diagnoses, insurers received a payment of about $3,000 a year. But when Chris looked into patients' follow-up care, many of them weren't getting it.