GOP keeps citing Lewin Group study, unholy alliance of UnitedHealthCare and Heritage Foundation

(9 am. – promoted by ek hornbeck)

One Hundred Twenty Million Americans Will Lose Their Insurance! The words drip from the mouths of the GOP in their opposition to the public option. Of course it’s all bunk, but the details behind the Lewin Group which produced these numbers are worse.

First Rep. Pete Stark (D-CA) released a rebuttal of the Lewin Group study, revealing that the Heritage Foundation paid for study and that UnitedHealthCare owns the Lewin Group(PDF).

Then came a doozy from the Washington Post:

[T]he Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association, a physician’s group, of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied its parent company and other insurers with data that allegedly understated the “usual and customary” doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.

In January, UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994.

Health insurance plans have contractual obligations for payment based on a number of reimbursement schedules, one of which is usual and customary rates (UCR).  UCR is the charge for health care services or procedures that is consistent with the average rate or charge for identical or similar services in a certain geographical area.  Many insurers use independent UCR schedules for determining reimbursement. But in this case, UnitedHealthCare used UCR schedules from their own company.

What is alleged is that UnitedHealthCare engaged in self-dealing lowball UCR which provided unjust gains to UnitedHealthCare. Reimbursing doctors at lower UCR for out of network services meant that UnitedHealthCare paid less than the true average rate. This being an out of network transaction meant patients were left to pay a higher portion of the balance of the bill. This is a breach of contract. This was plainly a scheme for UnitedHealthCare to pay less than they are contractually obligated to pay and stick patients with the bill.

Rather than go to trial, it was worth $400 million to UnitedHealthCare to settle with the New York AG and the AMA. And I’m guessing that the spreadsheet warriors at UnitedHealthCare still came out ahead.

So not only do we have a study paid for by a conservative organization opposed to the public option, but it was written by a company owned by an insurance carrier opposed to reform and that got caught in a self-dealing relationship trying to rip off doctors and patients.

That’s what passes for integrity and independence for the GOP? This is the world class health care system that the GOP wants to preserve? This is the efficient private market that is worth protecting? Insurance carrier profits at the expense of both doctors AND patients. Now that’s a winning combination. I wonder how many electoral votes that’s worth?

Although disclosure of Lewin’s ownership by an insurance carrier was known in DC as far back as April, it received almost no media mention. The media continue to uncritically repeat GOP assertions of Lewin being independent and nonpartisan. Pia Christensen writes at the blog for the Association of Health Care Journalists on how the media are perpetuating the myth that Lewin is nonpartisan:

Some reporters writing about this development, and other issues, are still referring to the Lewin Group as a nonpartisan organization, yet AHCJ president Trudy Lieberman pointed out in April that the group is ultimately part of United Healthcare Group, a major insurance company. Lieberman turned up evidence indicating that there may be no formal protections in place for Lewin Group’s editorial independence.

However, in recent stories, ABC News, The Washington Post, Investor’s Business Daily, KPCC, a southern California public radio station, and other news outlets continue to describe the Lewin Group as “nonpartisan.” And, while the Lewin Group does refer to itself as “objective,” it’s probably not a good idea to overlook their corporate ties entirely.

No formal protection for editorial independence sure sounds like all the problems we had with Wall Street firms and their non-existent firewalls between their research analysts and investment bankers.

The GOP pushes a narrative written and paid for by opponents of health care reform, and the media mindlessly repeats the “independent” findings. It is time to turn the tide on this study. Letters to the editor to your paper and newsmagazines, emails and calls to your local, national, and cable news of choice are in order everytime this study is cited.  You can use this handy media contact list for some of the major news outlets.