Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs - Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs EPISODE 53
Marshall Allen | ProPublica Journalist
00:00:00 00:39:12

Marshall Allen | ProPublica Journalist

Topics:

  • Misaligned incentives
  • Fraud, Waste, and Abuse
  • Health Insurance
  • Consumer spend
  • Medicare
  • National Provider Identifier

In this episode, Michael introduces you to Marshall Allen, an Investigative Journalist at ProPublica. Join us as we discuss how Marshall pierces the healthcare facade by investigating and reporting on stories that highlight the dysfunctional elements of the healthcare system that negatively impact consumers and patients, including his most recent article, “Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You”

Here’s a glance at what we discuss in this episode:

  • ProPublica focuses on investigative journalism that is in the public’s interest related to the abuse of power across industries 
  • What inspired Marshall to become an investigative healthcare journalist and the types of stories he focuses on
  • How fraud, waste, and abuse impacts all consumers of healthcare 
  • How a personal trainer without a medical license was able to obtain multiple National Provider Identifier numbers under the same name
  • Why Medicare doesn’t regulate who they assign the National Provider Identifier number to 
  • How both Medicare and health insurance companies allowed a convicted felon to bill for fraudulent medical services 
  • How the employee out-of-pocket cost in the benefit design was circumvented and how self-funded employers were the biggest losers in this fraudulent activity
  • How the fraudulent billing scheme was discovered and reported to major insurance carriers and why very little was done to take action to curb the fraud
  • How misaligned incentives impact the initiative to address fraud in the health care system 
  • Approximately 10% of the 1.2 trillion dollars spent in the American healthcare system is fraudulent and stealing 
  • How the lack of resources at the Texas state department of insurance impacted their ability to investigate and address the fraudulent billing activity
  • Different approaches the insurance companies and the government could have taken to combat this fraudulent activity 
  • A facade has been created to generate high spend within the healthcare system that has led to unnecessary complexities and passivity
  • How Marshall seeks to expose that all the players in the healthcare system are colluding against the payors in a system designed to extract as much money as possible from payors and consumers
  • How the shift in insurance cost share directly impacts employee’s financial wellness and how 1 in 5 Americans have medical claims in collections 
  • The role employer leadership must play in order to address lowering healthcare costs
  • Contact Marshall at marshall.allen@propublica.org 
  • Visit https://www.propublica.org/topics/healthcare
  • Visit https://www.propublica.org/series/the-health-insurance-hustle