Lawmakers are calling on health insurance regulators to address troubling 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 concerns raised by a New York Times investigation into MultiPlan, a data firm that works with insurance companies to recommend payments for medical care.
The investigation found that MultiPlan and insurers can collect higher fees when payments to medical providers are lower, leaving patients with large bills. Employers can also be charged high fees, sometimes paying insurers and MultiPlan more for processing a claim than the doctor receives for treating the patient. This opaque fee structure and alleged self-dealing are driving up healthcare costs, according to the lawmakers.
MultiPlan’s business model focuses on employer-based insurance, where employers self-fund their health coverage and use insurance companies to process claims. Insurers like Aetna, Cigna, and UnitedHealthcare promote MultiPlan’s services as a way to save money when employees seek out-of-network providers. However, the fees charged by MultiPlan have surprised some employers, with examples of high fees being charged for reducing medical bills significantly.
In response to the lawmakers‘ concerns, MultiPlan stated that their services lower overall healthcare costs by minimizing or eliminating balance bills for patients. However, the lawmakers are pressing the Labor Department for details on its efforts to enforce rules promoting transparency and exposing conflicts of interest in the healthcare industry.
Companies that operate health plans for their employees are required to monitor service providers and ensure reasonable fees. However, employers often struggle to obtain and understand the data showing what they’ve been charged and why. In 2020, Congress mandated service providers to disclose potential financial conflicts of interest, but it remains unclear if these rules apply to companies like MultiPlan.
The lawmakers‘ letter also questioned how the Labor Department is enforcing disclosure requirements and whether it plans to issue clarifying rules. With limited resources, the department has one investigator for every 8,800 plans, making it challenging to police health plans effectively.
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 an ongoing challenge. Despite these challenges, MultiPlan has established a corporate and government affairs team to address the issues raised.
Overall, the concerns raised by lawmakers and ongoing investigations highlight the need for greater transparency and accountability in the healthcare industry to protect patients and employers from rising costs and potential conflicts of interest.