Doc Pay Cuts Sparked Strife at Insurer; Cerebral Can’t Pay Up; Rumor Researchers

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Doc Pay Cuts Sparked Strife at Insurer

UnitedHealth Group systematically cut its payments to out-of-network doctors for emergency department (ED) visits and mental health care, sparking internal tension, according to newly unsealed court documents reported by Bloomberg.

“The records open a window into the workings of its UnitedHealthcare unit, the largest U.S. health insurer, and shed light on a bitter battle between financial heavyweights in the $5 trillion U.S. medical system,” the article stated.

An April 2021 email thread showed internal dissent about reductions in payments for psychotherapy, according to the news outlet. One member of a specific health plan serviced by the company, who was married to a therapist, questioned why reimbursements had dropped.

Other documents showed how the company planned to drastically cut out-of-network ED payments, which would have put it below national averages. “I’m not saying it’s the wrong thing to do to lower the reimbursement threshold,” a senior vice president at the insurer said of the ED reimbursement changes. “What I am struggling with is acting as though there won’t be member impact.”

The documents come from a lawsuit in Oklahoma brought by physician staffing firm TeamHealth, a lawsuit won by the insurer.

Cerebral Can’t Pay DOJ Fine

Telehealth company Cerebral will pay more than $3.6 million for engaging in practices that encouraged the unauthorized distribution of controlled substances — but it also can’t afford to pay a second similar fine, according to federal prosecutors.

The additional fine of $2.9 million “has been deferred in light of the company’s current financial condition,” according to a press release from the U.S. attorney’s office for the Eastern District of New York. Payment will be deferred for the term of the non-prosecution agreement that Cerebral entered into with prosecutors, and it will be waived as long as the company remains in compliance.

Cerebral will have to cooperate and provide information to the U.S. for at least the 30-month term of the agreement, prosecutors said.

“Cerebral’s exploitation of telemedicine flexibilities deceived patients who were legitimately seeking medical care, putting them at risk in exchange for profit,” Anne Milgram, administrator of the Drug Enforcement Administration, said in a statement. Cerebral came under fire in 2022 for its alleged overprescribing of attention deficit-hyperactivity disorder medications, which it began prescribing via telehealth in February 2021.

Misinformation Researcher Becomes Subject of Rumors

Misinformation researchers at the University of Washington have spent the last 5 years studying how rumors swirl — particularly around elections — and have become the subject of rumors themselves, Science reported.

Kate Starbird, PhD, began studying how rumors evolve long before that. Starting around 2013, she said rumors and misinformation were becoming a greater part of public discourse, and they were less frequently being corrected. When corrections did come out, they usually came too late and reached fewer people, the article stated.

In 2019, Starbird co-founded the university’s Center for an Informed Public, a collaboration between its information school, law school, and school of engineering, with a goal of resisting strategic misinformation, promoting an informed society, and strengthening democratic discourse. The team worked through the COVID pandemic and the 2020 presidential election, and attempted to help curb rumors in the 2024 presidential election.

Unsurprisingly, Starbird has become the target of harassment and threats, notably by Republicans in the U.S. House of Representatives who painted her as part of a “censorship industrial complex.” The House Judiciary Committee launched an investigation in early 2023, alleging Starbird supported a censorship regime, and interviewed her in June 2023.

Starbird told Science the interview was “superstressful,” in part because she felt obligated to be perfect in defending her and her colleagues’ research. “It’s like you have to talk in a way that’s completely bulletproof all the time, because the worst person in the world is going to try to take something you say and leak it,” she said.

Please enable JavaScript to view the comments powered by Disqus.