Lawmakers are calling on health insurance regulators to address concerning practices that are driving up costs for patients and employers. In a letter to a top Labor Department official, Representatives Bobby Scott of Virginia and Mark DeSaulnier of California highlighted the findings of a New York Times investigation into MultiPlan, a data firm that works with insurance companies to recommend payments for medical care.
The investigation revealed that MultiPlan and insurers can benefit from lower payments to medical providers, leading to higher fees for patients and employers. In some cases, employers end up paying more for processing a claim than the doctor receives for treating the patient. This opaque fee structure and alleged self-dealing have raised concerns about transparency and conflicts of interest in the healthcare industry.
MultiPlan’s business model focuses on employer-based insurance, where employers self-fund medical claims and use insurance companies like Aetna, Cigna, and UnitedHealthcare to process claims. MultiPlan’s services are marketed as a way to save money when employees seek care out of network, using an algorithm-based tool to generate recommended payments.
However, the fees charged by MultiPlan have surprised some employers. In one instance, UnitedHealthcare reduced a $152,594 hospital bill to $7,879 using MultiPlan’s services and then charged the employer a $50,650 fee. MultiPlan defended its practices, stating that their services lower overall healthcare costs for patients.
Despite MultiPlan’s claims, concerns about profiteering at the expense of employers and patients persist. Companies like Kraft Heinz and union health plans have filed lawsuits against insurers like Aetna and Blue Cross Blue Shield, alleging improper payments and undisclosed fees. Employers are legally required to monitor service providers and ensure reasonable fees, but obtaining and understanding billing data can be challenging.
In response to these issues, Congress mandated disclosure of potential financial conflicts of interest in 2020. However, it remains unclear whether these rules apply to companies like MultiPlan. Lawmakers are pressing the Labor Department to enforce disclosure requirements and issue clarifying rules to address these concerns.
In addition to congressional scrutiny, MultiPlan is facing lawsuits from medical providers alleging collusion with insurers to suppress payments. The company’s stock price has suffered, and its CEO acknowledged media scrutiny as a challenge. Despite these challenges, MultiPlan has established a corporate and government affairs team to navigate the ongoing controversy.
Overall, the investigation into MultiPlan’s practices has shed light on the complexities and potential conflicts in the healthcare industry. Lawmakers and regulators are working to ensure transparency and fairness in healthcare billing practices to protect patients and employers from rising costs.
