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Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Med Spas and Dangerous Infections

A boom of med spas appear to be fueling a rise in dangerous infections linked to unsanitary practices at these unregulated facilities, according to .

The number of these facilities has ballooned in recent years while generating about $15 billion for services like IV therapy, skin care, and cosmetic products, according to the report. Despite the growth and popularity, some of these unregulated facilities are employing unlicensed workers to administer injections of unapproved products in unsanitary conditions, the report stated.

One customer interviewed for the investigation, Bea Amma, reported developing sores at more than one hundred injection sites after a visit in 2021. Amma had requested injections of vitamins and a supposed fat-reduction compound called deoxycholic acid. She developed sores within 24 hours and eventually tested positive for Mycobacterium abscessus. After she recovered from the infections, she was left with scars.

The rise in such cases led FDA to issue last year that explained most shots for reducing fat, such as Aqualyx and Lipodissolve, are unapproved. The warning letter also cautioned that some facilities are inappropriately mixing products without proper sterilization.

While there are no federal regulations governing these facilities, they are subject to oversight at the state level, which typically requires that medical professionals are on staff. But experts told NBC News that rule is rarely enforced.

While government oversight of these facilities appears to be rare, one professional society, called the American Med Spa Association, has attempted to fill the gap for roughly 4,000 med spas across the U.S by offering legal and business resources to ensure proper operation.

Despite those efforts, experts interviewed for the investigation warn that the number of patients presenting with adverse effects related to services from these facilities appears to be growing.

Hospitals Compound Trauma for Transgender Youth

Amid a politically turbulent backdrop, hospitals across the country lack the necessary training and resources to appropriately treat transgender youth during periods of crisis, according to .

Hospitals have been stuck between political efforts to ban gender-affirming care and patients and medical associations that say the treatments are safe and critical for the mental health of this vulnerable population. The result has been a healthcare system that lacks the resources needed to address crisis periods for transgender youth, which often adds to the trauma experienced by patients, according to the report.

In particular, North Carolina has become a microcosm of the issue, according to the report. The state's legislators recently enacted new limits on gender-affirming care, and hospitals struggle with a lack of resources to treat pediatric mental health conditions, especially for transgender youth.

For example, one patient interviewed for the investigation, Callum Bradford, said his care at a UNC hospital left him regretting his experience and feeling worse than when he arrived.

After initially presenting to the UNC hospital following a prescription drug overdose, Bradford needed to be transferred due to a lack of available beds, according to the report. But the hospital planned to transfer him to a girls' mental healthcare unit, an inpatient ward inconsistent with his gender identity. That provoked a severe anxiety attack for Bradford.

Experts told the AP that those scenarios should never happen for transgender youth, regardless of a hospital's resource limitations.

One expert, Jack Turban, MD, MHS, the director of the gender psychiatry program at the University of California San Francisco, told the AP that "[i]f you don't validate the trans identity from day one, their mental health's going to get worse. ... Potentially, you're sending them out at a higher suicide risk than they came in."

UnitedHealth's Secret Rules to Restrict Rehab Care

UnitedHealth Group reportedly used secret rules to restrict access to rehabilitation services for patients enrolled in Medicare Advantage plans who were often seriously ill, living in nursing homes, or suffered cognitive impairment, according to .

A review of internal documents showed that previously unknown rules were implemented to quickly deny referrals from patients on these health insurance plans, often without informing doctors or their patients of the criteria used to make those decisions.

Those rules were kept in place until early November, when clinician reviewers were suddenly told to stop following them, according to the report.

The investigation noted that the decision to abruptly stop using those restrictive rules appeared to coincide with increased scrutiny of Medicare Advantage plans from federal legislators and CMS officials.

Reviewing clinicians who reportedly used those restrictive rules to deny rehab care referrals worked for a subsidiary of UnitedHealth called NaviHealth, which covers more than 15 million patients across various insurers, according to the report.

Employees of NaviHealth told STAT News the sudden change showed the previous restrictions had little basis in clinical evidence. In fact, referrals from patients living permanently in nursing homes were rarely approved by NaviHealth reviewers, according to the investigation.

A NaviHealth spokesperson rejected those claims from employees and emphasized that the documents reviewed for the investigation were intended only for the most complex cases. The spokesperson also said they did not know the denial rates for those cases.

These rules that effectively automatically deny referrals for rehab care appeared to fit with other reports from STAT News that found by NaviHealth, such as the use of algorithms to screen referrals, according to the investigation.

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