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Notes -
Well not really, no.
Something to keep in mind is that healthcare combines some of the worst parts of business, government, and the academy (also some of the best at times, but nobody wants to hear about that haha).
For example often we are forbidden by law to take steps to save money. If someone walks into the ED with an emergency and says "you can do whatever you want but I ain't paying for it" ...we do our best to save the guy's life. Ethical considerations often increase spending. Risk aversion too - nobody wants to see a bad outcome, nobody wants to get sued for a bad outcome so we spend more to prevent both.
One of the benefits of the oddity is that most people involved in healthcare are mission and martyr oriented. Physicians do a ton of free work and are expected to do this. Every year for the last thirty years or so pay has gone down, work has gone up (generally administrative tasks like what we are discussing here). Medical complexity has increased thanks to advancements in technology. A lot of problems in healthcare have been solved with "fuck it the doctor will take care of it." It is common for admin staff to quit or get fired and no replacement is hired, they just expect the doctor to do it, is a normalized thing.
However because the doctor generates value by seeing patients and billing for clinical responsibilities (and not typically by hours worked), and its just assumed that administrative responsibilities get done, these kind of things can easily not end up on a balance sheet in a meaningful way (at least to the hospital, I'm sure the insurance company has spreadsheets showing an advantage from sketchy behavior). Things that a lawyer or accountant would bill for? Nope, untracked and unpaid.
Successfully getting through medical school and residency requires an enormous ability to put up with bullshit, do nonsensical things, and work insane hours. We make do until we can't. People might take three days of vacation and spend the entire time catching up on paperwork. A family practice doctor might be done seeing patients at 3pm and spend the next 3-5 hours on paper work and other responsibilities.
It is very common in healthcare to see truly absurd things going on because healthcare doesn't (and to some extent shouldn't) function like a business. You see academy woke/DEI bullshit, spending hundreds of thousands to millions of dollars on unrelated politics. You see a posting for a physician that remains unfilled for half a decade because they are offering 80% of regional salary expectations. Even knowing that hiring the physician would bring in 5 times the salary in revenue. It doesn't make financial sense, but they just do it anyway because anyone with actual business acumen wants to shoot themselves dealing with medical horseshit and avoids it.
One of the biggest examples of the post-COVID era was travel nursing. During COVID a lot of nurses were like okay I need a pay bump from 1 to 1.1. Hospitals were like fuck off. So the nurses quit, or unionized and went on strike. So the hospitals decided to bring in travel nurses that were being paid 5. And then kept them. For years. At any point they could have gone back and paid 1.1 and gotten the original workforce back. Nurses would quit their jobs, sign onto a travel agency, and then work at the same hospital they used to work at and make more than a physician. It was hilariously dumb.
But that's healthcare.
And if they do have business acume, someone shoots them! Heyoo!
I mean, here's some examples from the Joe Rogan subreddit of all places.
https://old.reddit.com/r/JoeRogan/comments/1hb0c2d/i_dont_care_how_he_grew_up_he_right/m1co69q/
Is this kinda stuff "illegal?" Probably, but you have to be fined or prosecuted enough to make it unprofitable for the companies to stop doing it. United is ahead of the curve of unethical behavior, and the system tolerates it for now, but it is unethical and it is fraud, they are just good at getting away with it for the moment (ish, considering recent murder).
It's very much like companies who ignore environmental regulations and just break the rules. Does it make the company money to break the rules? Yes, the fines aren't enough.
Is it bad? Also yes.
Edit: I should clarify why I'm saying this -> I think it's important to say that rampant fraud is not business acumen, even if you can get away with it. It's just unprosecuted criminal activity.
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