ProPublica report illustrates the influence that a single lobbyist can have on CMS policy decisions that take billions away from doctors and redirects it to insurance companies.
The report shows how payers routinely require doctors to sacrifice up to 5% of the money owed to them if they want to be paid electronically. According to the report, even when physicians ask to be paid by check to avoid the fees, insurers often reenroll them in the electronic payments against their wishes.
From a doctor perspective, the most alarming part of the report shows that these fees were initially prohibited by CMS, but in August of 2017, the part of the website outlining the prohibition was removed, opening the door for insurers to make money from doctor payments.
According to ProPublica, the language was removed due to lobbying that came primarily from one individual – a former CMS employee turned lobbyist for Zelis, a private-equity backed company that processes payments.
Some payment companies share part of the fees they collect with the payers, meaning the insurance company is getting paid to transfer money it owes to doctors by taking a percentage of the payment.
Zelis told ProPublica that its service removes obstacles that keep providers from efficiently initiating, receiving, and benefitting from electronic payments. It also says that doctors can easily opt out of its services – a claim the report refutes.
The payment companies assert they are not breaking any rules.
The ProPublica report stems from the work of a doctor, Alex Shteynshlyuger, a New York City urologist, who requested public records from CMS to try to understand what was happening behind the scenes regarding the fees. What he found was an agency that regularly deferred to the lobbyist – in several instances, the lobbyist responded to his complaints to CMS instead of the agency itself.
The report outlines friendly exchanges between the lobbyist and CMS officials, who regularly deferred to him, and when it didn’t, was threatened with legal action.
The American Medical Association and 90 other physician groups have urged the Biden administration to reinstate the ban on fees, and the Veterans Health Administration is flat our refusing to pay what it deems illegal fees to the payment companies. CMS, meanwhile, says it has no jurisdiction over insurance companies’ business partners.