Doc pay cuts led to disagreement at insurer; Cerebral cannot pay; Rumor investigators

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

Doc pay cuts led to disagreement at insurer

UnitedHealth Group has systematically reduced its payments to out-of-network physicians for emergency room (ED) and mental health visits, leading to internal tensions, according to recently disclosed court documents reported by Bloomberg.

“The data opens a window into the inner workings of the UnitedHealthcare unit, the largest U.S. health insurer, and sheds light on a bitter battle between financial heavyweights in the $5 trillion U.S. medical system,” the article said.

An April 2021 email thread revealed internal disagreement over the reduction in psychotherapy payments, the news outlet said. One member of a specific company health plan, who was married to a therapist, wondered why reimbursements had dropped.

Other documents showed how the company planned to dramatically reduce out-of-network ED payments, bringing them below national averages. “I’m not saying it’s wrong to lower the reimbursement threshold,” a senior vice president at the insurer said of the changes to emergency room reimbursement. “What I struggle with is pretending there won’t be an impact on the members.”

The documents come from a lawsuit in Oklahoma filed by physician staffing company TeamHealth, a lawsuit that the insurer won.

Cerebral cannot pay DOJ fine

Telehealth company Cerebral will pay more than $3.6 million for engaging in practices that encourage the illicit distribution of controlled substances — but also cannot afford to pay a second similar fine, according to federal prosecutors.

The additional $2.9 million fine “has been deferred in light of the company’s current financial condition,” according to a news release from the U.S. Attorney’s Office for the Eastern District of New York. The payment will be deferred for the duration of Cerebral’s non-prosecution agreement with prosecutors and 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 life of the agreement, prosecutors said.

“Cerebral’s exploitation of the flexibility of telemedicine misled patients legitimately seeking medical care, placing them at risk in exchange for profits,” Anne Milgram, administrator of the Drug Enforcement Administration, said in a statement. Cerebral came under fire in 2022 for allegedly overprescribing ADHD medications, which it began prescribing via telehealth in February 2021.

Researcher of misinformation becomes the subject of rumors

Disinformation researchers at the University of Washington have spent the past five years studying how rumors spread — especially around elections — and have become the subject of rumors themselves. Science reported.

Kate Starbird, PhD, began studying how rumors evolved long before that. From around 2013, she said rumors and misinformation became an increasing part of public debate, and was corrected less often. When corrections did come out, they usually came too late and reached fewer people, the article said.

In 2019, Starbird co-founded the university’s Center for an Informed Public, a collaboration between the information school, the law school and the engineering school, with the aim of resisting strategic disinformation, promoting an informed society and strengthening democratic discourse. The team has weathered the COVID pandemic and the 2020 presidential election, trying to help curb rumors during the 2024 presidential election.

Unsurprisingly, Starbird has become the target of intimidation and threats, particularly from Republicans in the US House of Representatives who portrayed it as part of a “censorship industrial complex.” The House Judiciary Committee launched an investigation in early 2023, alleging that Starbird supported a censorship regime, and interviewed her in June 2023.

Starbird told Science the interview was “super stressful,” 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.