The Big Story

Reporter Marshall Allen has been investigating the confounding way we pay for healthcare for over a year. Today, we published his latest piece, Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You, which Marshall calls one of the wildest stories he’s ever reported. It begins in 2014 when a woman discovered her ex-husband, a personal trainer, was billing insurance companies for millions, despite the fact that insurance companies typically only pay for care that’s medically necessary and provided by licensed practitioners, like doctors or nurses. The details only get more surprising from there.
 

More From This Investigation

What Can Be Done Right Now to Stop a Basic Source of Health Care Fraud

Fraud is one reason we all pay so much for health care. But there are simple fixes that would make it more difficult for scammers to operate.

Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose

The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.

Your Medical Devices Are Not Keeping Your Health Data to Themselves

CPAP units, heart monitors, blood glucose meters and lifestyle apps generate information that can be used in ways patients don’t necessarily expect. It can be sold for advertising or even shared with insurers, who may use it to deny reimbursement.

You Snooze, You Lose: Insurers Make The Old Adage Literally True

Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook.

In Montana, a Tough Negotiator Proved Employers Don’t Have to Pay So Much for Health Care

With its employee health plan in financial crisis, Montana hired a former insurance insider who pushed back against industry players with vested interests in keeping costs high. She proved, essentially, that bargaining down health care prices works.

Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing.

Why Your Health Insurer Doesn’t Care About Your Big Bills

Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank.

Do You Work in the Health Insurance Field? ProPublica Is Investigating the Industry and We’d Like Your Help

We need your perspective on the health insurance hustle.