Is a Trojan horse lurking behind transparency push?
Regarding the article “Health insurance giants to make payment data accessible to public” (ModernHealth care.com, May 14) the Health Care Cost Institute is, according to its website, “supported by Aetna, Humana, Kaiser Permanente and United-Healthcare to promote independent, nonpartisan research and analysis on the causes of the rise in U.S. health spending.”
HCCI is going to build a database of healthcare payments based on claims data submitted by health plans. That reminds me of something. Oh, yes, Ingenix, the UnitedHealth Groupowned database of usual and customary charges that, according to the New York attorney general, was manipulated by health plans through selective contribution of claims data in order to bilk plan enrollees of hundreds of millions of dollars in benefits.
One wonders why health plans might want to send claims data to a plan-supported, not-for-profit enterprise that is collecting payment information. Could it be that by selectively submitting claims with lower payments (i.e., deeply discounted contracted payments), the plans could leverage this data in negotiations with providers for deeper discounts, or change legislature and regulator perceptions of the reasonable value of provider services?
Fair Health is an established notfor-profit that already has such a database of payments, and it was funded by the fines levied against the plans that abused the Ingenix scheme. It has an elaborate audit mechanism in place to ensure that claims data submission to the database are not selective. That is where this data ought to be collected and accessed. I see the tracks of a Trojan horse.
Dr. Myles Riner Mill Valley, Calif.