September 26, 2019

Congress Questions Role of Private Equity Groups in Surprise Billing Battle

There have been several bills introduced in both the Senate and the House addressing surprise billing. However, as of mid-September 2019, none of the bills have been brought to a vote. There is disagreement among the relevant stakeholders regarding the appropriate process for preventing surprise bills for patients. In general, health plans advocate for setting a standard rate based on the geographic market for services when there is a disagreement between a health plan and an out-of-network provider regarding payment for services. On the other hand, provider groups are advocating for an arbitration or negotiation process when there is a disagreement over reimbursement for services. Provider lobby groups have recently come under scrutiny in the media as it was revealed that many of these provider lobbying groups are actually funded by private equity firms that allegedly profit from surprise billing. On September 16, 2019, the House Committee on Energy and Commerce launched an investigation into private equity firms and their role in the fight over surprise billing legislation.