[Annie Waldman at ProPublica]

UnitedHealth Group has been using an algorithm to determine whether patients have been receiving "too much" therapy and then cutting them off:

"Around 2016, government officials began to pry open United’s black box. They found that the nation’s largest health insurance conglomerate had been using algorithms to identify providers it determined were giving too much therapy and patients it believed were receiving too much; then, the company scrutinized their cases and cut off reimbursements."

The kicker here is the regulatory arbitrage: the practice has been ruled illegal in three states so far, but United simply undertakes its activities to a state where it's still legal. And because it doesn't answer to a single regulator, it's hard to impose stronger rules. In fact, more than 50 regulators each have jurisdiction over small slices of United's activities.

Effectively that makes it ungovernable:

"For United’s practices to be curbed, mental health advocates told ProPublica, every single jurisdiction in which it operates would have to successfully bring a case against it."

And:

"State regulators are supposed to be making sure private insurers that manage Medicaid plans are following the mental health parity laws. But this year, a federal audit found that they were failing to do so. “They are not well designed to essentially be watchdogs,” Lloyd said. “There’s very little accountability. Insurers can run roughshod over them.”"

In other words, the system needs to be radically overhauled if patients are going to receive adequate care. Will it be? Perhaps not soon.

#Health

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