Tainted research spurred Congress to pass an insurance-friendly federal law
Questionable research on surprise billing became the focus of testimony last week during TeamHealth clinicians’ ongoing trial against United. By video deposition Friday, United Health Network CEO Dan Rosenthal testified about the research and United’s role in editing Yale University researchers’ manuscript.
The research project, authored by Yale professors Zack Cooper and Fiona Scott Morton, first made headlines in 2016. Their increasingly high-profile results caught the attention of prominent D.C. lawmakers, who consulted the researchers. Cooper and Scott Morton published two more papers, expanding their analysis of surprise billing, and Cooper made at least a dozen trips to Washington to meet with lawmakers. Throughout these presentations and meetings, TeamHealth’s practices, vision, and culture were repeatedly mischaracterized. Ultimately, these unfounded fears led to the passage of the “Surprise Medical Billing Act,” which has, in turn, fostered the tens of billions in profits enjoyed by United and other insurance companies. Despite concerns about the biased nature of the research, the Yale results have heavily impacted the Biden administration’s Interim Final Rules, guiding implementation of the “No Surprises Act.” In fact, Cooper’s work was cited more than a dozen times in those Rules.
The Cooper-Scott Morton results were cited by former U.S. Senator Lamar Alexander (R-Tenn.) when he introduced the “Lower Health Care Costs Act” (S.1895). Sen. Alexander gave a graphic portrayal on the Senate floor of U.S. emergency department staffing practices, claiming they represented a “market failure” being “exploited” by companies like TeamHealth. The Senator cited the Yale research as a basis for supporting the “Lower Health Care Costs Act”, quoting Cooper’s claim that companies including TeamHealth “engage in fairly unsavory billing practices.”
“These assertions are unfounded and do not reflect the truth accurately in any way”, said Carol Owen, TeamHealth’s Chief Counsel of Revenue Payment Integrity. “TeamHealth has a long-standing policy against balance billing, avoids putting patients in the middle of billing disputes, and has a generous charity care policy.”
Last week’s testimony in the Nevada trial linked to revelations earlier this year about United’s involvement in supporting and modifying the research results published by Cooper, Scott Morton, and Yale graduate student Nathan Shekita. The research, presented at the White House, the U.S. Department of Justice, the Federal Trade Commission, and elsewhere, was publicized as a straightforward academic research study. Now, however, it is associated with the allegation that United manufactured the “surprise medical billing” crisis and then persuaded Congress to pass legislation to address this “crisis.”
Furthermore, connections have now surfaced among Cooper, the commercial health insurance industry, and certain “nonprofit” institutes. Cooper’s resume shows that his work on out-of-network billing, healthcare spending, and related issues has been funded for more than six years by the National Institute for Health Care Management. Health insurance executives populate NIHCM’s board and the group provided financial support to the Yale study that is at the center of the current controversy.
TeamHealth’s more than 15,000 clinicians continue to watch the trial closely. At stake is the very ability of heroic frontline healthcare providers to get necessary reimbursements from large profitable insurers to cover the cost of the lifesaving care they provide. For more details, see ProtectingOurHealthcareHeroes.com. To watch the proceedings in real-time, tune in to the livestream (Meeting ID: 541 907 772) from 8:30 a.m. to 4:45 p.m. (Pacific Time).
About TeamHealth
At TeamHealth, our purpose is to perfect the practice of medicine, every day, in everything we do. We are proud to be the leading physician practice in the U.S., driven by our commitment to quality and safety and supported by our world-class operating team. To improve the experience of our physicians and advanced practice clinicians, we empower clinicians to act on what they believe is right, free clinicians from distractions so they can focus on patient care, invest in learning and development to promote growth in the clinical field and foster an environment where continuous improvement is a shared priority. Through our more than 15,000 affiliated healthcare professionals and advanced practice clinicians, TeamHealth offers emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic surgery, general surgery, obstetrics, ambulatory care, post-acute care and medical call center solutions to approximately 2,900 acute and post-acute facilities and physician groups nationwide. Join our team; we value and empower clinicians. Partner with us; we deliver on our promises. Learn more at www.teamhealth.com.
The term “TeamHealth” as used throughout this release includes Team Health Holdings, Inc., its subsidiaries, affiliates, affiliated medical groups and providers, all of which are part of the TeamHealth organization. “Providers” are physicians, advanced practice clinicians and other healthcare providers who are employed by or contract with subsidiaries or affiliated entities of Team Health Holdings, Inc. All such providers exercise independent clinical judgment when providing patient care. Team Health Holdings, Inc., does not have any employees, does not contract with providers and does not practice medicine.
The collective term “United” as used throughout this release references defendants, UnitedHealthcare Insurance Company (“UHIC”), United HealthCare Services, Inc. (“UHS”), UMR, Inc. (“UMR”), Sierra Health and Life Insurance Co., Inc. (“SHL”), and Health Plan of Nevada, Inc. (“HPN”).
Case Name is Fremont Emergency Services (Mandavia), et al. vs. UnitedHealth Group, Inc et al. Case number is A-19-792978-B.