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Analysis

Bipartisan Investigation Into Surprise Billing Practices Expands

By Jack O'Brien  
   December 19, 2019

The congressional probe now includes physician staffing companies and health insurers.

Congressional leaders announced the expansion of a bipartisan investigation into surprise billing practices Thursday afternoon.

The probe, led by leaders from the Senate Health Education Labor and Pensions (HELP) Committee and the House Energy and Commerce (HEC) Committee, now includes physician staffing companies and health insurers.

Senate HELP Chairman Lamar Alexander, R-Tenn., Senate HELP Ranking Member Patty Murray, D-Wisc., HEC Chairman Frank Pallone, D-N.J., and HEC Ranking Member Greg Walden, R-Ore., wrote a letter discussing efforts taken by Congress to address issues associated with out-of-network charges to patients.

The letter was sent to physician staffing companies and insurers, including: Envision Healthcare, TeamHealth, Anthem Inc., Cigna Corp., CVS Health, Health Care Service Corporation, Highmark, and UnitedHealth Group.

"We are concerned about the impact of surprise billing on the nation’s rising health care costs and the devastating effect that the practice is having on Americans," the leaders wrote in the letter. "Therefore, we request your assistance to understand better why surprise billing occurs, the policies and practices that help protect individuals from surprise billing, and the current incentives behind the negotiations between providers and insurers." 

Lawmakers are requesting information about when a provider is not in-network with a patient's insurance company, especially relating to surprise billing practices, and the relationship between staffing companies and private equity firms.

The letter builds on a HEC investigation launched in September to examine KKR & Co. Inc., Blackstone Group, and Welsh, Carson, Anderson, & Stowe, the private equity firms that own Envision and Team, regarding their role in surprise billing activities.

Insurers are being requested to provide information about negotiations with staffing companies about reimbursement rates and what steps payers have taken to protect members from receiving surprise bills.

The expansion of the investigation also comes days after a Health Affairs study found that Annual healthcare spending for patients with employer-sponsored health insurance would drop by $40 billion if specialists were not allowed to bill out-of-network.

That research was in line with the findings of a Kaiser Family Foundation report released in June which found that one in six Americans received a surprise medical bill in 2017 despite having commercial health insurance coverage. 

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


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