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Senators complain that MultiPlan tool leads to ‘bizarrely low’ health care prices

US Capitol building in Washington, DC, on Wednesday, March 6, 2024. Photo: Diego M. Radzinschi/ALM US Capitol building in Washington, DC, on Wednesday, March 6, 2024. Photo: Diego M. Radzinschi/ALM

Senator Ron Wyden and Senator Bernie Sanders say the MultiPlan Data iSight tool is just too good at keeping health care bills low.

Wyden, a Democrat from Oregon, is chairman of the Senate Finance Committee, and Sanders, an independent from Vermont, is chairman of the Senate Committee on Health, Education, Labor and Pensions.

Wyden and Sanders wrote MultiPlan CEO Travis Dalton last week to ask the company to inform committee staff about the Data iSight tool.

“Because your company gets paid more when it reaches lower payment amounts, payments to healthcare providers are often much lower than the billed amount, with some describing these amounts as ‘crazy low,’” Wyden and Sanders told Dalton.

The senators asked Dalton to brief their committees on the concerns about Data iSight raised by The New York Times, whether or not they believe they are classified as fiduciaries under the Employee Income Security Act and whether they hold a prohibited license requested and received. US Department of Labor transaction exemption for Data iSight fee income.

The New York Times reported on April 7 about the use of the Data iSight repricing tool.

Health insurers and employer health plans can use the tool to assess the reasonableness of out-of-network providers’ bills and then decide whether to pay the claim, negotiate a lower price, or pursue another strategy.

Adventist Health System and Community Health Systems are two of the hospital owners who have filed antitrust lawsuits against MultiPlan over the Data iSight system because they believe the payments adjusted using the Data iSight tool are too low.

The No Surprises Act now aims to protect insured patients from large, unexpected medical bills related to emergency care or the arrival of out-of-network providers at in-network hospitals. But patients can still get “surprise bills” under other circumstances.

According to press reports, employers’ use of Data iSight to review claims is, in some cases, leaving patients “with sky-high medical bills to pay,” Wyden and Sanders wrote in their letter.

MultiPlan, in a response to the Adventist lawsuit, claims that hospital companies object to the Data iSight system because it prevents hospitals from forcing patients to pay much higher prices for care in some hospitals than they pay for the same care in other hospitals.

“Using antitrust law to suppress competitive innovation and thereby gain the upper hand – all to inflate profits by forcing patients to pay substantially higher prices for the exact same medical services – is as wrong as it sounds,” according to MultiPlan.

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