Vermont Sen. Bernie Sanders and Oregon Sen. Ron Wyden are seeking information from MultiPlan after an April 7 New York Times report found that major insurers made millions in fees by using the data analytics firm to determine how much to pay for out-of-network claims.
MultiPlan helps plans handle out-of-network claims, advising insurers what to pay providers. According to the Times, the plans often pay much less than providers bill — and charge self-funded employers a percentage of the savings as a processing fee. The formula incentivizes payers to pay providers less so they can charge employers higher fees. Meanwhile, patients are potentially responsible for the remainder.
"We are concerned that you company’s Data iSight product improperly drives up patient health care costs and, further, that the financial incentives built into the fee for the use of the Data iSight product result in an improper conflict of interest between determining a plan’s liability for out-of-network claims and the plan’s duty to provide promised benefits pursuant to [the Employee Retirement Income Security Act]," the senators said in a May 22 letter.
The senators are requesting that the company submit a briefing about the allegations contained in the Times no later than June 5. They said the briefing should include:
- A description of whether the company disclaims ERISA fiduciary status as part of its service contracts for the use of DataiSight.
- Whether the company believes any ERISA prohibited transaction class exemption applies to fees it receives with respect to Data iSight.
- Whether the company has ever applied for and been granted a prohibited transaction exemption from the Labor Department with respect to fees it receives with respect to Data iSight.
MultiPlan told Becker's in a statement that the company "plays a critical role in the healthcare system by helping lower out-of-pocket costs and reducing or eliminating medical bills for millions of patients."
"We are working with the committees to address their questions and explain the cost and complexity patients can face when obtaining out-of-network medical services, especially when many providers charge many times more than what they charge Medicare and commercial in-network patients for the same services," MultiPlan said. "We are committed to helping make healthcare transparent, fair, and affordable for all."
Mr. Sanders and Mr. Wyden are not the only senators scrutinizing MultiPlan in the wake of the Times report. Minnesota Sen. Amy Klobuchar called on the Justice Department and the Federal Trade Commission to investigate potentially anticompetitive conduct by the company.
MultiPlan is also facing multiple lawsuits from health systems alleging the company conspired with major payers to underpay providers by tens of billions annually. Among those suing include Franklin, Tenn.-based Community Health Systems. In response to that lawsuit, a MultiPlan spokesperson told Becker's, "We believe this lawsuit has no merit, and we look forward to disproving these baseless allegations."