What happens when a corporate health insurance company, Change Healthcare, a division of UnitedHealth Group, has its computer system hacked and can’t pay claims electronically? Even when Medicare claims are at issue, the Centers for Medicare and Medicaid Services (CMS) can only urge UnitedHealth to behave ethically. Darius Tahir et al. report for Kaiser Health News that physicians, hospitals and pharmacies are left in the lurch.
Our health care system is so poorly designed that even when a government program is involved, the government can do little more than ask the insurer to mitigate a problem–even serious problems such as inability to pay electronically about 50 percent of all physician claims–voluntarily. The insurer wants to spend as little money as possible to resolve the problem and feels no ethical, let alone legal obligation, to find a workaround. One advocate nails the problem: “the purely optional, do-this-out-of-the-goodness-of-your-heart model clearly is not working.”
UnitedHealth appears in no rush to help providers, saying its systems for paying claims will get fixed later this month. In the meantime, it has created inadequate workarounds. It is offering practices with hundreds of thousands of dollars in weekly revenue as little as $540 a week.
CMS is asking UnitedHealth to do better. Providers need more money. Alternatively, CMS is suggesting that providers file paper claims or switch away from Change Healthcare to a different company to pay their bills, which for many providers is easier said than done.
The White House is also asking UnitedHealth to do more to help ensure providers are reimbursed appropriately and without delay.
Meanwhile, some pharmacies are asking patients to pay the full cost of medications. Some physician practices are struggling to pay their bills. They are out millions of dollars.
Policymakers and experts would like the Biden administration to do more. But, except with regard to claims it pays directly in Traditional Medicare, it has limited authority since it turned over Medicare Advantage claims payment to corporate insurers. Congress should reconsider the consequences of the government not fully controlling claims payment in our healthcare system.
Saad Chaudhry, an executive at Maryland hospital system raises a darker issue. What is UnitedHealth really up to? He asks, “Do you believe these thieves? Do you believe the organization itself, that has everything riding on their public image, who have incentives to minimize this kind of thing?” Whether you believe UnitedHealth or not, health care providers and their patients should never be in this situation.
How does the government protect against cyberattacks down the road, when our health care system is so fragmented? There are scores of cyberattacks each year against health care entities. For sure, the government should require system redundancies so that if one insurer is hacked providers have other options for getting paid. But, if the government were in control of claims payments, it would have the power to do whatever workarounds were necessary to ensure payment to providers if its systems were hacked.
Congress should be on top of this now. One thing’s for sure. Cyberattacks will continue.
Here’s more from Just Care:
- Bi-partisan group of Senators call for better Medicare Advantage data to protect enrollees
- 33 experts call on CMS to continue reining in Medicare Advantage overpayments
- Three big Medicare access to care issues put vulnerable people at serious risk
- Medicare Advantage: Denials and more denials, some deadly
- Take advantage of the Medicare Advantage Open Enrollment period
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