Functional Integrative Internal Medicine | Primary Care Doctor in Gainesville, Florida

Dear Senator Rubio, 

As a fellow UF alumnus and member of Florida Blue Key, I'm reaching out to you about the dire situation my practice has suffered with paralyzed cash flow since 2/21/2024 from the Russian cyberattack on UnitedHealth Group's  subsidiary, Change Healthcare which is the clearinghouse that my billing company uses. 

I am Angeli Maun Akey, MD FACP, a private practice primary care and internal integrative medicine doctor for nearly three decades. A Gainesville native, I pursued my undergraduate education at the University of Florida through the medical honors program, followed by my medical degree at the University of Florida College of Medicine, and completed my training in internal medicine at Yale-New Haven Hospital in Connecticut. After spending a couple of years in Palm Beach County, I returned to my hometown in 1999 to raise my family. My practice has been open since 2000, marking a quarter century of service to this community. I am dedicated and determined to continue that service despite UnitedHealth Group's continued failure to completely restore the payment portal and its callous disregard for my patients and small front line medical practices like mine.  

I also want to make sure you know that this national healthcare emergency has received only scant coverage in the news outside of trade publications but it is having a dire impact on your constituents here in Gainesville.

Here's the recap: On February 21st, UnitedHealth Group subsidiary Change Healthcare, suffered a malicious cyberattack by the Russian BlackCat ransomware criminals, affecting 94 percent of hospitals in the United States, as reported by the Wall Street Journal and the American Hospital Association. From the perspective of my practice, North Florida Integrative Medicine, this attack has disproportionately affected small practices like mine. It froze our billing processes, leading to an 80 percent decrease in cash flow, putting our practice at significant financial risk. Currently, my team (comprising two Physician Assistants and a Nurse Practitioner and twelve employees) and I serve 3500 patients in the North Florida area. Our practice stands out for offering integrative, functional primary care medicine in an insurance-based model. Most practitioners in the functional integrative medicine space do not take insurance.  And, we are in a primary care shortage area designated by HRSA.

Due to this unforeseen collapse in cash flow, our model may need to change but even that comes with significant impact for my patients. I have been fortunate to collaborate with Representative Kat Cammack and Florida Senator Keith Perry, working to bring attention to the situation and secure advances from Medicare and our other major insurance companies. But at best, that's extremely temporary, limited and will only be enough to cover overhead for barely two weeks. In addition, I am asking our elected representatives for help from our banks to offer loans with zero percent interest because of this situation.

It has been eight weeks since this has occurred and it's our patients that have loaned us money to stay afloat. With a letter that I gave them asking for $45 when they are seen, they have responded with that and much more. They are committed to helping us stay in practice. Even though this occurred almost 8 weeks ago, and Blue Cross and Blue Shield patients represent 70% of our practice, we just received our first check this week. This is helpful but insufficient.

What's particularly galling however, is the response from UnitedHealth Group. Despite nearly $400 billion in revenues, it has clearly allocated an insufficient amount to cybersecurity or in the alternative, to providing advances and emergency distributions on an expedited easy to access basis, to distressed medical practices like mine. I have attempted a dozen times to access its assistance to doctors portal through "OPTUM Pay." I have been unable to access those rescue funds even as I read that UnitedHealth Group claims to have released $6 billion dollars to assist medical practices and hospitals.

Make no mistake - UnitedHealth Group is 100% responsible for this cyber failure and the devastating effect on my practice. Despite my extensive practice history It has not stepped into the breach with one dollar whereas my patients are zero percent responsible for the threat to my practice, yet, they have fronted approximately $40K dollars so that my people can be paid and we can continue to serve them. This is a pathetic scenario. 

UnitedHealth Group posted in a press release in January 2024 that they had record revenue of $371 billion in 2023 with net profit of $22 billion. When I saw that, I immediately thought of how many denials they're healthcare insurance subsidiaries have given my patients for MRI's, medications, rehabilitation and mental healthcare. I wonder how many of those patients, many of them senior citizens, have been subject to the algorithmic denials they are using to juice profits at the expense of patient care. These are the subject of multiple class action lawsuits. I also thought that if they had $22 billion dollars in PROFIT from 2023 alone, and they have only disbursed $6 billion dollars to help us, then they have plenty of cash on hand to more than make this right. 

This has been so disruptive and I believe UnitedHealth Group has to be held accountable. The ability of one company to be so vertically integrated and pervasive that it can cause this kind of catastrophic outcome to our healthcare system including practitioners and the public needs a serious, thoughtful and probative review. This cannot be allowed to stand, become normal or get swept under the rug by blaming unknown criminals to whom UnitedHealth Group allegedly paid a $22 million ransom for the first hack. Then came the second one. The jury is still out on that episode. 

This story is much bigger than me and my practice.  This is about UnitedHealth Group causing financial distress for small practices and then buying them out. I am just one of small independent medical practice who has been put on the verge of bankruptcy with little care on the part of this company.  When I heard that they bought out CORVALIS Health Primary Care clinics in Oregon, that they helped put in distress, I realized how dangerous and predatory this has become. 

https://www.beckerspayer.com/m-and-a/optum-receives-green-light-on-emergency-purchase-of-oregon-clinic.html

When doctors are employed by venture capital or large corporations, they are beholden to shareholders. When they are independent such as myself, we are beholden by our ethical duties to care for the patient in front of us. 

The hearing on 4/16 in the U.S. House is documented in this article and says that the U.S. Senate Finance Committee is planning a hearing with UnitedHealth Group CEO Andrew Witty on April 30th.Rep. Annie Kuster suggested that UnitedHealth Group might need to be subpoenaed to testify.  

https://www.beckershospitalreview.com/cybersecurity/lawmakers-express-fury-toward-unitedhealth-in-first-change-attack-hearing.html

I would like to testify at this hearing and would be willing to cancel my clinic and fly to Washington DC at my own expense because UnitedHealth needs to know that the small independent practices which are the backbone of primary care, are continuing to be severely and adversely affected by the Change Healthcare outage.  While payments to large healthcare organizations and larger practices than mine I'm sure are appreciated by those entities, my small practice and my 3,500 patients should not be facing closure because I'm being ignored by the UnitedHealth Group organization. This is just wrong. 

In the end if small independent practices like mine close, are bought out by a large corporate entity (such as venture capital, hospital systems, or insurance companies), in the end the patient loses.  They lose the personalized relationship with their doctor and their healthcare team which was the motivation for many of us who chose primary care even though it's the lowest paid of all the medical professions.  

I implore you to allow me to be the face of front line primary care at the Congressional hearing of the Senate Finance committee on April 30th. This massive company is crushing us and hurting our patients. Hurting your constituents. This cannot be allowed to continue unabated and unaccountable. 

Thank you for your kind consideration, 

Angeli Maun Akey , MD, FACP, ABOIM/ ABIHM, ABAARM, IFMCP