To Protect Bottom Lines, Insurers Don’t Pursue Widespread Fraud–They Simply Pass Costs Off To Consumers
ProPublica looks at the industry mindset on fraud within the health insurance marketplaces. The bottom line is this: If a con artist, or a corrupt medical professional, makes off with health care dollars, those losses don't necessarily fall on the insurers. In other health industry news: a unique alliance geared toward saving members thousands on health coverage; a look at who is invested in keeping surprise medical bills; and more.
We Asked Prosecutors If Health Insurance Companies Care About Fraud. They Laughed At Us.
Like most of us, William Murphy dreads calling health insurance companies. They route him onto a rollercoaster of irrelevant voice menus, and when he finally reaches a human, it’s a customer service rep who has no idea what he’s talking about. Then it can take days to hear back, if anyone responds at all. The thing is, Murphy isn’t a disgruntled patient. He prosecutes medical fraud cases for the Alameda County District Attorney’s Office in Oakland, California. And when he calls insurers, he’s in pursuit of criminals stealing from them and their clients. But, he said, they typically respond with something akin to a shrug. “There’s no sense of urgency, even though this is their company that’s getting ripped off.” (Allen, 9/10)
How To Make Health Insurers Take Fraud Seriously
In most states, laws require private health insurers to submit information to regulators about suspected fraud in their networks. Such reporting helps everyone by highlighting scammers and their schemes. For instance, a doctor could be billing several insurers for services that weren’t provided, a hospital could be uniformly gaming billing codes to pad profits or a fraudster could be targeting several insurers pretending to be a medical professional. (Allen, 9/10)
As Polis Touts Price Drops From Summit County Health Insurance Alliance, Hospitals Are Skeptical It Can Work Statewide
Gov. Jared Polis, standing before a crowd in Keystone, unveiled an eye-popping number on Monday. $14,000. That is how much he said a family of four in Summit County will be able to save on their health insurance next year through the new Peak Health Alliance, compared with what they’re paying now. ... he used the announcement on Monday to again talk about taking the idea statewide, fundamentally changing the leverage points in the Colorado health insurance market. ... Hospitals, which have been supportive publicly of the Peak Health Alliance’s work, say they’re not sure people across the state can get the same kind of deal the folks in Summit County are getting. (Ingold, 9/10)
Kaiser Health News:
Investors’ Deep-Pocket Push To Defend Surprise Medical Bills
As proposals to ban surprise medical bills move through Congress and state legislatures with rare bipartisan support, physician groups have emerged as the loudest opponents. Often led by doctors with the veneer of noble concern for patients, physician-staffing firms — third-party companies that employ doctors and assign them out to health care facilities — have opposed efforts to limit the practice known as balance billing. They claim such bans would rob doctors of their leverage in negotiating, drive down their payments and push them out of insurance networks. (Bluth and Huetteman, 9/11)
Kaiser Health News:
Virginia Governor And UVA Vow To Revamp Practice Of Suing Patients As CEO Exits
Gov. Ralph Northam and the president of the University of Virginia committed to changing UVA Health System’s collections practices a day after Kaiser Health News detailed its aggressive and widespread pursuit of former patients for unpaid medical bills. At the same time, the health system announced the departure of CEO Pamela Sutton-Wallace, who will leave in November to join New York-Presbyterian Hospital as a senior vice president. (Hancock and Lucas, 9/10)
Read The First KHN story: ‘UVA Has Ruined Us’: Health System Sues Thousands Of Patients, Seizing Paychecks And Claiming Homes