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

Doc Pay Cuts Spark Dispute at Insurer

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

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

According to the news outlet, an email thread in April 2021 showed internal opposition to cuts to psychotherapy payments. A member of a private health plan served by the company who is married to a therapist questioned why reimbursements had dropped.

Other documents showed how the company planned to drastically cut out-of-network emergency room payments, which would drop it below national averages. “I’m not saying there’s anything wrong with lowering the reimbursement threshold,” a senior vice president at the insurance company said of the emergency room reimbursement changes. “What I have a hard time with is acting like there won’t be any member impact.”

The documents come from a lawsuit filed by physician staffing company TeamHealth in Oklahoma and won by the insurance company.

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.

According to a press release from the U.S. attorney’s office for the Eastern District of New York, the additional fine of $2.9 million “was suspended considering the company’s current financial condition.” The payment will be delayed for the duration of Cerebral’s non-prosecution agreement with prosecutors and waived as long as the company remains in compliance with the rules.

Cerebral will be required to cooperate with the United States and provide information for at least the 30-month duration of the agreement, prosecutors said.

“Cerebral’s use of telemedicine flexibilities deceived patients legally seeking medical care and put them at risk for profit,” Drug Enforcement Administration administrator Anne Milgram said in a statement. he said. brain came under fire in 2022 for allegedly overprescribing attention deficit hyperactivity disorder medications, which he began prescribing via telehealth in February 2021.

Misinformation Investigator Subject to Rumors

Misinformation researchers at the University of Washington have spent the last 5 years studying how rumors circulate, particularly about elections and becoming the subject of rumors themselves. Science reported.

Kate Starbird, Ph.D., began examining how the rumors developed long before that. Starting in 2013, rumors and misinformation became a larger part of public discourse, and they were corrected less frequently, he said. The article noted that when fixes do come out, they often arrive too late and reach fewer people.

In 2019, Starbird co-founded the Center for an Informed Public, a collaboration between the university’s information school, law school, and engineering school to resist strategic misinformation, promote an informed society, and strengthen democratic discourse. The team worked through the COVID pandemic and the 2020 presidential election and tried to help quell rumors about the 2024 presidential election.

Unsurprisingly, Starbird became the target of harassment and threats, especially from Republicans in the US House of Representatives who portrayed it as part of the “censorship industrial complex”. The House Judiciary Committee launched an investigation in early 2023, alleging that Starbird supported the censorship regime, and interviewed him in June 2023.

Starbird told Science the interview was “extremely stressful” because he felt obliged to be perfect in defending himself and his colleagues’ research. “It’s like you always have to sound completely bulletproof, because the worst person in the world is going to take something you said and try to leak it,” he said.