CONGRESSMAN PAT RYAN RELEASES SHOCKING RESULTS OF OPTUM COMMUNITY INQUIRY, SUBMITS FULL SET OF DATA TO THE DEPARTMENT OF JUSTICE, HEALTH AND HUMAN SERVICES, AND FEDERAL TRADE COMMISSION FOR FURTHER INVESTIGATION
Congressman Pat Ryan Releases Shocking Results of Optum Community Inquiry, Submits Full Set of Data to the Department of Justice, Health and Human Services, and Federal Trade Commission for Further Investigation
The bombshell report out of Congressman Ryan’s office includes thousands of community responses detailing the avalanche of dysfunction at Optum-owned medical practices in the Hudson Valley
Chief among the concerns raised by the community were a declining quality of care, an increase in fees and incorrect billing, and issues with customer service and accessibility negatively impacting people’s ability to get health care
OptumHealth, a subsidiary of UnitedHealth Group, has purchased medical practices across the Hudson Valley, including more than 2,500 providers at CareMount Medical and Crystal Run Healthcare
WASHINGTON, DC – Today, Congressman Ryan released the shocking results of his community inquiry regarding the quality and accessibility of care at Optum-owned Hudson Valley medical practices. Over 1800 responses from Optum patients illuminated a deeply troubling pattern surrounding Optum’s care quality, accessibility, and billing practices. Several providers also responded to the inquiry, citing how treatment of staff has suffered from the switch to Optum, further contributing to a general decline in the quality of care administered. Ryan is now submitting the full dataset to the Department of Justice, Department of Health and Human Services, and Federal Trade Commission for further investigation and imminent action.
“The volume of responses, the specificity of issues, and the frankly heartbreaking stories involved are unlike anything I’ve seen in my time in Congress. I’ve heard from disabled children unable to get treatment. Mothers waiting almost a year for a cancer diagnosis. Families sent into debt because of overcharges for treatments never even received. All so the largest health care company in the world can continue to make record breaking profits,” said Congressman Pat Ryan. “I’ve already been in touch with Optum to get folks help on an individual basis in the short term, but that’s just a band-aid. Today I’m formally submitting every single piece of data to the Department of Justice, the Department of Health and Human Services, and the Federal Trade Commission for further investigation. And I will be pushing around the clock for further action. For anyone not convinced urgent change is needed, read every damn story below. When our Hudson Valley community stands up with one voice, anything is possible.”
“We are deeply grateful for Congressman Ryan’s leadership advocating for Optum patients and their dedicated caregivers in the Hudson Valley,” said George Gresham, President of 1199SEIU United Healthcare Workers East, the largest and fastest growing healthcare union in the nation. “New Yorkers' access to quality healthcare is at risk as for-profit corporations take over doctors’ practices in our communities. Optum must prioritize patient care over profits and invest in good quality healthcare jobs which are essential to meeting New York’s healthcare needs.”
Over 36% of Optum patients who responded to the inquiry said they've experienced serious customer service issues that have interfered with their care, which many say has only worsened since Optum took over. Most commonly, they cited intense difficulty with Optum’s phone system, which no longer allows patients to call their doctor’s office directly – meaning, for example, that someone can’t ask a nurse a question about their medication or a receptionist about sending medical documents to their employer or kid’s school. Instead, patients are sent to a call center with wait times that can extend up to several hours, with no guarantee that their message will be read or responded to. In addition to causing significant frustration for patients, this has led some to miss out on critical medications.
“What Optum has done is put a corporate wall between my children and their physician and therefore their overall health,” said Naomi from Marlboro. “After the Optum takeover, their doctor became less attentive and less relaxed in our visits, and seemed to need to push us out the door to see the next patient. Their phone tree method of triaging patients is an absolute disaster. I have waited for hours and hours for a call-back while my kids are sick. I am working towards leaving them, though I've discovered that there are very few alternatives in the area and am nervous about finding the right fit for my kids since we're starting over from scratch.”
“The accessibility of people who work at Crystal Run has gotten so much worse since Optum took over,” said Marc Buchannan of Rock Tavern. “If I need to ask a nurse a simple question, or get the results of a test–something fairly common as I have a disabled son who has a lot of medical needs– it can take weeks to get a response. Even if they finally do call you back, trying to actually speak with a provider is impossible. We’ve taken to scheduling appointments, even when my son is healthy, just to talk to a real person.”
“I’ve been a patient with Crystal Run for over a decade, and customer service has severely gone downhill since the Optum purchase,” said Sabrina Salagean of New Paltz. “Appointments get repeatedly cancelled without explanation, and it’s impossible to get in touch with someone on urgent matters like medication refills. I have called Crystal Run twice a week since February 7 asking for medication and each time I waited over 40 minutes on hold just to leave a message. My calls are left unanswered, and it’s been a month since I’ve taken my thyroid medication because I no longer have refills and they aren’t getting back to me.”
25% of Optum patients who responded to the inquiry said that they have experienced inaccurate or double billing, along with an increase in unexplained fees, since Optum purchased their medical practices. In many cases, patients faced extreme difficulty getting Optum to rectify their bills or reimburse them for erroneous charges, in some cases waiting over a year to get reimbursed.
“I have been dealing with billing issues for over a year which started with my pregnancy. I am still waiting for a $660 refund from January of last year, where Optum kept billing my insurance incorrectly,” said Catherine Zagoreos of Poughkeepsie. “I have called numerous times and each time they tell me they will fix the issue, and check back in 30-45 days. When I call back the next technician tells me the last one made a mistake, and to call back in another 30-45 days. Over a year later I still keep calling, and still waiting for them to refund me for THEIR billing mistakes. It’s exhausting.”
“Optum incorrectly processed doctor’s visits for my son, which led to an overcharge that wasn’t covered by insurance,” said Sarah from Wappingers Falls. “I paid the copay amount in good faith and called to have the bill corrected. I was told they would resubmit and I never followed back up because I assumed they would do their job. I got a collections notice in the mail from Optum – both of those incorrectly coded items that I had disputed! Optum’s billing practices are criminal and I’ve started looking for a new provider for myself and my family.”
41% of Optum patients who responded to the inquiry said they had experienced reductions in the quality of care they receive at Hudson Valley medical practices after their purchase by Optum. In addition, 49% reported difficulty getting appointments, 37% reported increased wait times, and 33% reported difficulty seeing their preferred doctor. People cited significantly shorter appointment times, rushed doctors, and an inability to get questions answered or prescriptions filled.
“I am a full-time caregiver for my elderly, ill 86-year-old father. We have to use Crystal Run on a near daily basis, and I am appalled at the inadequacy of the care my father has received,” said Diane from Montgomery. “You can’t even get someone on the phone anymore to answer simple questions, so I end up rushing my dad to the emergency room. No one should have to feel this kind of stress and pressure. There have been several times my father could have died before we heard back from Crystal Run. It’s completely unacceptable. I’m a full-time advocate for my dad and I still can’t get him the care he desperately needs. I can’t bear to think about the other seniors navigating the abysmal system all alone. Something needs to change.”
“I have had no shortage of negative experiences since Optum took over my medical practice. I tried for more than a year to get an appointment with a specialist and kept getting pushed off, my appointments were repeatedly cancelled,” said Kimberley from Tivoli. “Once I finally did get in, it turned out to be cancer. They made me wait a year to be seen, and it was cancer. I was incredibly lucky that it wasn’t too late. I’ve had to go without essential medication for days, despite calling in my refills, because Optum has messed up my prescriptions. Most recently, I went in for a torn rotator cuff. The doctor, who I could only see by walking in, said he needed to see me again in a week. That was nearly a month ago and I haven’t been able to get back in. I’ve been lucky so far, but someone is going to die if they don’t get these problems under control.”
“I love the providers that I see at Optum. They are kind, and always do their best to discuss treatment options with me so I can make an informed decision regarding my health,” said a Middletown Optum patient. “It is the practices of the company that make the experience nightmarish. I’ve had to wait for days following critical tests, making stressful times that much worse. Most recently I couldn’t get my diabetic medication. It took me threatening to go to the news or sue to get the prescription filled, and even then I ended up missing a week of my medication. I’m so glad that Congressman Ryan is pressuring this company, because staff and patients alike are clearly suffering.”
In addition to concerns raised by Optum patients, several current and former Optum employees and providers also responded to the community inquiry, raising alarm bells of their own. They cited concerns around the treatment of staff, nearly all of them reporting that they are overworked, undervalued, and forced to compromise patient care to keep up with Optum’s corporate standards. Several longtime care providers have left the company due to burnout, contributing further to many of the delays and issues patients now face.
“I have been an Optum employee and patient for 24 years, and the way that my colleagues and I are being treated is harming us and our patients,” said Marie, an Optum employee from Wappingers Falls. “We used to have floating staff to fill in and help where we needed, but now if someone’s out we have to do double or sometimes triple the work. This year I was informed I wouldn’t be getting a raise, we usually get 1-2% to adjust to cost of living increases, because my salary for my position maxed out. I always have excellent annual reviews. This is how Optum treats their employees while making billions.”
“I worked at Crystal Run for a long time, and can confidently say that the purchase by Optum has accelerated the decline in the patient experience. The management doesn’t listen to the providers, and makes it near impossible for them to leave and provide care elsewhere in the Hudson Valley. They don’t care that we’re overworked, and manage us through fear and edict,” said a former Crystal Run provider. “The care given in the office is still great care. The doctors are still doing a great job, but they are overwhelmed, under staffed and have very low morale. The patients are suffering for this, and it won’t stop unless someone holds the corporate machine accountable.”
“I worked at Crystal Run Healthcare in the laboratory. Once Optum took over, we were laid off within a year due to them closing the lab and sending all bloodwork out to Quest. We all lost our jobs,” said a former Optum employee. “It has been devastating for all of us as we try to recover from this huge life change and setback, and patients have suffered from making everything less local. Everything is less accessible, and hard working Hudson Valley locals had their jobs outsourced and have been left out to dry.”
In 2022, Optum purchased CareMount Medical, a medical group with over 2,100 providers and 1.6 million patients in the tri-state area. In 2023, Optum further consolidated the market for physician services in the Hudson Valley with its acquisition of Crystal Run Healthcare, with about 400 providers. Patients across the Hudson Valley have reported that the shift to Optum has worsened the quality of their care and reduced access to medical providers in our area. This includes difficulty scheduling doctor’s appointments, inaccurate billing, unexplained fees, long wait times, and poor customer service. In addition, Optum employees have reported layoffs and chaotic, overburdened work schedules, leading to staff burnout.
Across the country, Optum has purchased doctor’s offices at an aggressive pace. It has become the largest employer of doctors, with one in ten physicians nationwide now under its control. Optum’s parent company, UnitedHealth Group, also owns the largest insurance company, one of the three largest Pharmacy Benefit Managers, and the largest medical claims manager. United has used this vast power to rip off patients and enrich its shareholders, with profits of $14 billion in 2024.
In the Hudson Valley, concerning reports have emerged that United may be paying its own Optum practices more in order to squeeze local competitors, as well as manipulating patients’ medical records in order to receive higher payments under the Medicare program. United is facing multiple investigations by the Department of Justice, including an antitrust review of Optum’s acquisition of doctor’s offices that was opened in February 2024. According to reports, investigators are looking into anticompetitive harms for patients and providers.
Throughout his time in office, Congressman Ryan has always emphasized the importance of lowering costs, specifically when it comes to health care. He supports landmark legislation which has already lowered the prices of ten of the most common high-cost pharmaceuticals, fought to lower premiums for 20 million Americans receiving healthcare through the Affordable Care Act, and secured more than $2 million to expand services at Sun River Health in Beacon.
Congressman Ryan is a cosponsor of the Drug Price Transparency in Medicaid Act, which would prohibit PBMs from charging Medicaid more than they paid pharmacies for a drug. He also co-leads the Pharmacists Fight Back Act, comprehensive legislation to require adequate reimbursements to pharmacists, prohibit PBMs from steering patients to their own pharmacies, and eliminate PBM restrictions on patient choice. Large portions of these bills were set to be included in the December government funding legislation until they were removed at the last minute.
Congressman Ryan also recently reintroduced the Stopping Pharma’s Ripoffs and Drug Savings for All Act, as a part of his broader Affordability Agenda; the Congressman’s first legislation of the 119th Congress which aims to lower costs across the board. The Stopping Pharma’s Ripoffs Act would rein in Big Pharma’s current abuse of U.S. patent law, and make it easier to produce less-costly generic drug alternatives.
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