Marshall Allen investigates why we pay so much for health care in the United States and get so little in return. He is one of the creators of ProPublica’s Surgeon Scorecard, which published the complication rates for about 17,000 surgeons who perform eight common elective procedures. Allen’s work has been honored with several journalism awards, including the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and coming in as a finalist for the Pulitzer Prize for local reporting for work at the Las Vegas Sun, where he worked before coming to ProPublica in 2011. Before he was in journalism, Allen spent five years in full-time ministry, including three years in Nairobi, Kenya. He has a master’s degree in Theology.
The bipartisan proposal comes in response to a ProPublica story that showed how a personal trainer posed as a doctor to defraud prominent health insurers.
New Jersey’s health plan for school employees pays out-of-network providers virtually whatever they want. Dozens of acupuncturists and physical therapists earned more than $200,000 in 2018 from school staff alone. One brought in $1 million.
Según Dignity Health, la enfermera de emergencias no cumplió con la fecha límite para agregar a su recién nacida prematura a su plan de salud, lo que la hacía responsable de las facturas médicas. La empresa rechazó las apelaciones de su empleada durante un año hasta que ProPublica se puso en contacto con ellos.
Dignity Health said its employee, an ER nurse, failed to meet the deadline to add her premature newborn to its health plan, so she was responsible for the medical bills. It rejected her appeals for a year until ProPublica called.
Experts say both employers and working Americans end up paying more when health insurance companies don’t report fraud to regulators and prosecutors.
To protect their networks and bottom lines, health insurers don’t aggressively pursue widespread fraud, making it easy for scammers. Then they pass the costs off to you.
In response to a story by ProPublica and Vox that detailed how a Texas personal trainer was able to bilk private insurers for millions, six Democratic lawmakers are asking federal regulators to take action.
Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.
Fraud is one reason we all pay so much for health care. But there are simple fixes that would make it more difficult for scammers to operate.
A ProPublica story in February documented the hidden cash and gifts health insurers pay to influence independent brokers. In new proposed legislation, lawmakers say such fees should be revealed to employers.
Companies cash in by calling physicians “Super Doctor,” “Best Doctor” or “Top Doctor” and then selling them opportunities to boast about the honor. Experts call the accolades a “scam.” Giving me one highlights the absurdity.
The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.
CPAP units, heart monitors, blood glucose meters and lifestyle apps generate information that can be used in ways patients don’t necessarily expect. It can be sold for advertising or even shared with insurers, who may use it to deny reimbursement.
Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook.
With its employee health plan in financial crisis, Montana hired a former insurance insider who pushed back against industry players with vested interests in keeping costs high. She proved, essentially, that bargaining down health care prices works.
Some people say journalists are “godless.” But I spent five years in full-time Christian ministry, and my faith has made me a better reporter.
Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing.
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank.
Do You Work in the Health Insurance Field? ProPublica Is Investigating the Industry and We’d Like Your Help
We need your perspective on the health insurance hustle.
A study in Washington state found that in a single year more than 600,000 patients underwent treatment they didn’t need, at an estimated cost of $282 million. “Do no harm” should include the cost of care, too, the report author says.