• 

UNITEDHEALTH IN THE NHS

This is a shared post from POHG research and campaign group. It gives us information and requests our help. Please help if you have the time to do some google research through documents about your local area.

• In 2014, America’s largest health insurer UnitedHealth saw their President of global expansion installed as Chief Executive of the NHS in England.
• UnitedHealth has a track record of being fined for fraud against the US government, but these penalties do not ever seem to improve its conduct. UnitedHealth is currently being sued by the US Government in a case ongoing since 2017.  https://www.nytimes.com/2017/05/19/business/dealbook/unitedhealth-sued-medicare-overbilling.html
• UnitedHealth is right now embedding its subsidiary company Optum as an integral part of NHS GP care nationwide, through its financial control systems and IT systems (including the Scriptswitch software).  This insurance company has sold these Trojan Horse systems into the Clinical Commissioning Groups which control our GP services nowadays.

Case study – NHS Ealing Clinical Commissioning Group (CCG)

UnitedHealth subsidiary Optum has been installed in NHS Ealing CCG’s clinical and financial decision making, with tasks that require its access to patients’ confidential medical records.

One of Ealing CCG’s Joint Vice-Chairs has the following Register of Interests entry, which mentions Optum:  https://www.ealingccg.nhs.uk/media/147147/COI-GB-Members-Register-Aug-18-v3.pdf

Referrals

In 2015 NHS Ealing CCG expensively outsourced its referral management service to Optum; this included a transfer of staff to this UnitedHealth subsidiary. https://www.ealingccg.nhs.uk/media/1304/Paper_7_Referral_Facilitation_Service_-RFS-_Procurement.pdf

This “Referral Facilitation Service” (RFS) covers all GP referrals that come under eight speciality areas:

• Cardiology, Dermatology, Gastroenterology, Gynaecology, Uro-Renal (Nephrology and Urology), Paediatrics, Orthopaedics and Ear, Nose & Throat (see page 16 of this doc:https://www.ealingccg.nhs.uk/media/1428/Paper-10-Ealing-CCG-QIPP_Report-JUNE-2014.pdf , and https://www.bmj.com/content/356/bmj.i6856)

The RFS contract allows for provisional expansion in the future; e.g. extending to prior approval of all GP referrals to acute hospitals.

• In 2018 this three-year contract was extended to “Year 4”, and the contract itself anticipates a potential “Year 5”
  https://www.ealingccg.nhs.uk/media/146731/Ealing-CCG-Procurement-Decisions-May-2018.pdf

Optum, as referral gateway operator for NHS Ealing CCG, now decides which patients referred by their GP (primary care) to hospital (secondary care) will be funded out of the NHS CCG’s budget.

In other words, a UnitedHealth subsidiary now determines whether an Ealing GP patient who needs NHS hospital treatment of the above types is allowed to access it.

GP medical records access for UnitedHealth

The “Referral Facilitation Service” contract gives UnitedHealth access to the medical records of all patients registered with Ealing CCG’s GPs whose referrals it handles.

Might this situation explain why Ealing CCG’s Fair Processing Notice does not reference the data processor for referrals?https://www.ealingccg.nhs.uk/media/124323/eccg-fair-processing-notice-v2-0.pdf

How many NHS contracts like this are in place across the country already, positioning UnitedHealth to access commercially valuable patient data that the patients thought they had shared only with their family doctor?

We can all work together to identify and publicise where UnitedHealth and Optum are gaining footholds within our NHS

If you feed back what you find about all this in your area on to this and the Public Health list, and also share your information and the crowdsourcing request with all of your interested contacts, then soon we’ll all have a much clearer picture of this threat, and the specific contracts, locations and public officials involved.

Please use your access to search engines, libraries, experts and any other resources and contacts you can think of, to uncover and document deals that have been struck by UnitedHealth/Optum, and what roles they are in with your own CCG and neighbouring ones in your part of the country.