Immaculate, and False

The post: Jacob shared an HHS Inspector General review that found medical records didn't support the diagnosis codes in most sampled Medicare Advantage claims from two large insurers, which are contesting the findings. His point: a payer's own data has never been evidence that a payment was accurate.

Read Jacob Selsman's original post on LinkedIn →

My comment:

"A payer's own data has never been evidence that a payment was accurate" — same is true on the provider side, and I'm the proof.

Every claim my company submitted was documented. Every form would have passed inspection. That wasn't luck. My first profession, before healthcare, was writing ISO compliance documentation for auto suppliers. I knew exactly what auditors check and what they take on good faith before I was twenty-five.

Then a federal contractor actually applied scrutiny. Ninety-five percent of my lab's claims were ineligible for reimbursement. At my physician practices, one hundred percent.

Nothing about the paperwork changed. The only variable was whether anyone with authority was looking hard enough.

I pleaded guilty to $150 million, served eight and a half years, and owe a balance of $51 million in restitution.

The burden-of-proof point in your post is the whole thing. Self-reported data isn't evidence of accuracy — it's evidence of what someone chose to write down. I wrote mine, and it was immaculate, and it was false.

Originally posted as a comment on LinkedIn.