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Why Health Insurances can’t be trusted for Benchmarking—a thread #SurpriseBilling #surprisemedicalbills
1) Senate version of Balance Billing ban plans to use Benchmarking OON rates to 125% of median In-Network rates. khn.org/morning-breako…
2) plenty people have said why this is a bad idea, first & foremost it involves govt price controls & fee schedule (as opposed to IDP-type version seen in NY, TX BB laws) @SenateHELP @SenateGOP @marcorubio @ScottforFlorida @Forbes google.com/amp/s/www.forb…
3) but what I haven’t heard a lot about is how Insurances have manipulated OON. The most famous is Ingenix google.com/amp/s/www.mark…
4) ask NY & @NYGovCuomo about Ingenix. @UHC was accused of grand level fraud scheme which manipulated OON payments (for their profit, of course) managedcaremag.com/archives/2009/…
5) of course @UHC settled, & in part of settlement “admitted no wrongdoing”. But the fines helped setup @FAIRHealth, a 3rd party database which aggregates claims & which NY uses to settle OON bill debates b/n MD’s & Insurances ag.ny.gov/press-release/…
6) from the ashes of Ingenix rose Optum, the hybrid insurance titan which controls United’s databases, Davita, Surgery Centers, etc. healthcarefinancenews.com/news/secret-we…
7) Much like the Xmen movie, the Ingenix Phoenix Optum might be the strongest force in the Universe. It’s also probably evil
8) interestingly, Optum was also a key component of @HealthCostInst which some states are using to provide costs (no COI there) modernhealthcare.com/article/201901…
9) meanwhile let’s check in on CA, who recently passed bills ending BB through Benchmarking
10) Health Insurance Fraud! Rampant! publicintegrity.org/health/another…
11) I lose count of lawsuits. But it’s over one BILLION in federal fraud from Medicare Advantage schemes (for reference, Envision, the evil, huge powerful EM firm economists like to accuse of racketeering, only made $2B in 2018)
12) so just to recap, the largest EM group in country made 50% more in Revenue than Health Insurers are accused of defrauding the federal government.
13) for reference, UnitedHealth made 216 in revenue last year. In fact, United made more in Revenue than every EM group in country. But physicians have upper hand in negotiations, right @LorenAdler & @BrookingsInst
14) as a fun aside, the USCBrookings Schaeffer Initiative for health policy is named after Leonard Schaeffer. Who’s he? A billionaire who made his money off of...Health Insurance in California priceschool.usc.edu/people/leonard…
15) Wellpoint, the company Schaeffer admiringly & successfully brought out of near bankruptcy, has also been accused of fraud, including claims the company’s coverage is “largely illusory” google.com/amp/s/www.lati…
16) it’s also being sued by Federal government (I literally can’t keep track of fraud lawsuits—I think we’re at 4-5 in this thread) fiercehealthcare.com/payer/doj-clea…
17) but hey, a USC institute started by a Health Insurer magnate is unlikely to have bias, right?
18) well at least Senate knows enough to have a grain of salt from testimony from a health insurer institute, right? 
20) so apparently @NoSurpriseGap is biased, but economists working at Insurance institute for policy aren’t.
21) so to recap, @SenateGOP wants to institute a govt imposed fee schedule to hospital based doctors which will lead to 20% pay cuts (which were Draconian during SGR but apparently not now) bc economists from @BrookingsInst & @Yale (both of whom have HI ties for funding) say so
22) and per @USCBOcostest , all these savings from Draconian cuts will be passed on to conumers b/c the most trustworthy industry in the country, health Insurers, says they will
23) on top of that, insurers will be in charge of the databases providing rates. Despite they have never been trustworthy w/ databases...bc foxes shouldn’t guard the henhouse.
24) only solution is to have some form IDP, as proposed by bipartisan @CongressmanRuiz & @DrPhilRoe in @EnergyCommerce , so that someone can keep Insurances in check (since they can’t help but commit fraud every decade) @ACEPAdvocacy @AmerMedicalAssn @anesthesianews
