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MultiPlan, the secret back-end to most of the insurer industry, is going public

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In a recent announcement, MultiPlan, an entity offering a shadow provider network to insurers, declared that it was going public through a SPAC. Upon closer inspection, MultiPlan represents some of the worst aspects of American health care.

The world of health insurance is deliberately murky. There are monthly premiums, basically a subscription to access the insurance; deductibles, which are minimum amounts a patient pays before the insurance kicks in, usually in an emergency or surgery setting; and co-pays, which are additional fees the patient pays for the privilege of seeing a doctor, usually $20-70.

All of the patient-side fees are confusing, but the provider-side is even more so. Insurers handle negotiations with doctors and hospitals (and, importantly, negotiating with a doctor does not necessarily mean the insurer has negotiated with the hospital and vice versa) to reach a set price for a specific service. These prices are negotiated down from the hospital or physician’s chargemaster (a list of prices). The chargemaster bears no relation to actual charges but is instead the provider’s best attempt to set a high bar at the outset of a negotiation process. When an uninsured patient is billed an extraordinary amount, it’s usually because they didn’t have the negotiation layer of an insurer built in.

The purported value add of insurers, then, is that they lessen costs for patients by handling catastrophic expenses and negotiating down high provider fees.

For a few reasons, this isn’t wholly true. For one, health systems are increasingly merging with insurers, meaning any “negotiation” on behalf of the patient is happening within two divisions of the same company.

But also, many insurers are doing much less negotiation than they make it seem.

The corporation also uses a Palantir-like combination of algorithm and human to root out “fraud and abuse” in payments. 

Three weeks ago, a new merger announcement threw the health care world into a bit of a tizzy. MultiPlan, a complementary PPO network, announced it was going public via a SPAC. The announcement forced quite a few people to start looking up what MultiPlan actually does, including me.

MultiPlan, it turns out, is a corporation that handles a lot of insurers’ work for them. It handles negotiation with providers nationwide and consequently has the largest preferred provider network in the country. This means that insurers can contract with MultiPlan and simply get access to MultiPlan’s network, rather than doing thousands of negotiations. This service is so valuable that all 10 of the top 10 insurers use it, and the corporation seems to have carved out a little monopoly at the top.

MultiPlan didn’t start with so much power. It was founded in 1980 to solve an growing problem: when people traveled, their narrow network insurance plans didn’t follow them. If a person from Delaware had an accident in Colorado, they likely fell out of network and did not receive insurance coverage. To fill this gap, MultiPlan formed a network of “shadow contracts,” negotiated rates with providers that fell outside most networks, and sold this network to other insurance plans.

Over time, as the main insurers became bigger and more national, these shadow contracts became less important. But MultiPlan remained at the top of the insurer network, mostly because the Affordable Care Act of 2010 triggered an avalanche of startup insurers (Oscar, Clover, etc.) while also mandating that insurers cover out-of-network emergency care (although it did not ban surprise billing). MultiPlan offered these smaller insurers an easy way to access a large network of providers.

In 2006, private equity firms began eyeing MultiPlan as a valuable service with few competitors, a market position that only grew after the aforementioned 2010 ACA devlopments. Over the ten years from 2006 to 2016, MultiPlan changed hands between PE firms no fewer than four times. Meanwhile, MultiPlan was also making large acquisitions of competitors and firms in adjacent spaces:

  • 2006: MultiPlan acquired by Carlyle Group for $1 billion
  • 2006: MultiPlan acquires PHCS, the largest primary care network in the US
  • 2010: MultiPlan acquired by BC Partners and Silver Lake for $3.1 billion
  • 2010: MultiPlan acquires Viant, another competitor
  • 2011: MultiPlan acquires NCN, a reimbursement management platform
  • 2014: MultiPlan acquired by Starr Investment Holdings and Partners Group for $4.4 billion
  • 2014: MultiPlan acquires Medical Alert & Review, which identifies wasteful billing
  • 2016: MultiPlan acquired by Hellman & Friedman for $7.5 billion

Not only did MultiPlan’s value increase by a factor of more than 7 times over 10 years—its owners “cleaned up,” in the words of a Wall Street Journal blog post— it also acquired many of its potential competitors. To my knowledge, MultiPlan no longer has competitors. It’s just MultiPlan and the insurers that use it.

Following some of these acquisitions, MultiPlan expanded its service offerings beyond provider negotiation. The corporation also uses a Palantir-like combination of algorithm and human to root out “fraud and abuse” in payments. And for insurers who worry about what their members think of them, MultiPlan offers a set of analytics services that “balance[s] out-of-network savings and member service.”

From what I can tell, this means MultiPlan has a side business in blocking certain treatments and medications to save the insurer money, or at least making things very hard on doctors who try to prescribe expensive care.

This makes sense from MultiPlan’s perspective, as MultiPlan’s revenue (as far as I can tell—they’re not yet public) comes from a combination of the contract fees that insurers pay to access MultiPlan’s network, in addition to a percentage of the “savings” MultiPlan gets for insurers by routinely lowballing doctors.

Theoretically, MultiPlan’s harsh negotiation tactics should be good for rising American health care costs; insurers are supposed to lower costs by negotiating lower prices on behalf of the patient.

But instead, MultiPlan acts like a mafia enforcer for insurers, forcing doctors to accept low payments while insurance premiums for patients…somehow continue to rise.

MultiPlan’s key strategy for forcing doctors to accept low prices is by erecting a bureaucratic layer so thick and complicated that few can navigate it. On one MultiPlan fax to a doctor that I saw, MultiPlan gave the physician 8 days to respond to a low-ball negotiation. “Please note that if you do not wish to sign the attached proposal,” the fax said, “this claim is subject to a payment as low as 110% of Medicare rate as based on the guidelines and limits on the plan for this patient.”

In other words, if the physician disagrees with MultiPlan’s reimbursement offer, MultiPlan reserves the right to cut the price even lower.

MultiPlan preys on physicians using these subtly forceful faxes, expecting physicians’ medical billing staff to not have time to fight through layers of bureaucratic tape. And according to a friend who works in medical billing, even if a staff member takes it upon themselves to complain about a low rate to MultiPlan, MultiPlan refuses to negotiate on the grounds that it is not the insurer.

Now MultiPlan is going public via a SPAC. There’s a lot of money to be made in leveraging the fragmentation of the health care system and bending physicians to your will, and Churchill Capital looks ready to sweep it up.

Olivia Webb. (2020, August 5). MultiPlan, the secret back-end to most of the insurer industry, is going public. Acute Condition. https://www.acutecondition.com/p/multiplan-the-secret-back-end-to?fbclid=IwAR342wrhyNVpIY_mKp7HY8-6TlwXDFudVrJALD49ZZVvRbBJxdJnTAVyIp8

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“TAKE IT OR LEAVE IT,” IS HURTING PATIENT CARE

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DNY59 | Credit: Getty Images/iStockphoto

Coast Surgery Center of Huntington Beach, CA is suing some of the largest health insurance providers in the country; United Health Care, Cigna, Anthem Blue Cross of California, Blue Shield of California, Blue Cross Blue Shield Associates, and all Blue Cross Blue Shield affiliated companies for illegal, coercive, unfair, fraudulent practices, bad faith and deceptive advertisements.

When patients need a provider, they often look for an in-network provider to save them money but when a patient requires an out-of-network specialist or wants a provider they trust, insurance carriers like Blue Cross, utilize a separate rate for these out-of-network providers. Even before services are rendered to a patient, the out-of-network provider and facility obtain authorization with the insurance carrier for approval and are provided with the usual, customary, and reasonable (UCR) rate. Based on the UCR rate provided by the insurance, the provider and patient understand that if they are to proceed, how much the insurance company will reimburse.

This lawsuit arises because Blue Cross is intentionally underpaying Coast Surgery Center even after Coast had obtained authorization and was provided with the UCR rates from Blue Cross.  Blue Cross’s scheme was to significantly reduce the reimbursement rate from UCR to below Medicare rate and this is a “take it or leave it” offer.

For example, Coast Surgery Center billed Blue Cross $49,550 for a surgery and Blue Cross paid $202.99! Medical facilities cannot stay in business and offer quality service to patients when they are unable to cover rent, let alone utilities, supplies, and staff. Why would a patient purchase insurance coverage that’s hundreds of dollars a month when they can walk into a surgery center and just pay only $202.99 for their surgery? It’s inconceivable that Blue Cross can consider this “usual, customary, and reasonable.” Blue Cross was paying 75% – 100% of approved out-of-network charges to Coast Surgery Center prior to 2019 but since 2019 to July 2022, Blue Cross has only paid 1.59% of bills totaling over $6M, for the same procedures they have approved before, so how is this “usual, customary, and reasonable?”

Blue Cross collects billions of dollars from insurance premiums each year but is too greedy to pay out the providers that have rendered services to patients. Blue Cross is the middle man taking money from customers, paying pennies to the dollar to providers, and keeping a large chunk for themselves without having to lift a finger. Contrary to their claims that they care about reducing member healthcare costs, patients have been forced to pay more for their healthcare as a result of their scheming practices, while giving less access to providers of choice. If Blue Cross is not stopped, they will ruin out-of-network medical providers, patients will have limited choices, and the quality of care will diminish. Blue Cross is manipulating the system and have conspired with third-party servicers like Multi-plan to defraud many out-of-network providers by coercing them into servicing patients with authorization and then extorting the providers into contracts that only offer significantly reduced rates leaving them in an impossible position.

When deciding their health and the well-being of their families, patients want to be able to select their doctor based on their needs, not based on the insurance carrier’s pool of what they have to offer. Blue Cross forces patients to pay higher out-of-pocket costs for using out-of-network providers, ultimately, its practices increase costs and deprive patients of their right to choose their doctors.

Blue Cross and many large insurance companies pay lobbyists to help create laws that allow them loopholes to be able to get away with cheating their customers. Customers then purchase insurance policies that might not even cover them when they need it. When customers get frustrated and demand the insurance to pay or want to ring the alarm, the insurance company pays Medicare rate, instead of paying the UCR rates as they really should be. This doesn’t make any sense when insurance premiums increase annually, and coverage keeps decreasing.

California tax payers including patients, doctors, and facilities fund the Department of Insurance and the Department of Managed Healthcare (DMHC) so that they can ensure consumers of their healthcare rights and to protect consumers from being cheated. Yet these departments have ignored these insurance companies or are not aware of their tactics. These Departments should be protecting consumers and investigating these insurance payout processes because the insurance companies are working the system and using the loophole to scam customers of millions of dollars in premiums and paying out next to nothing or nothing at all. So the Dept of Insurance and DMHC should be protecting patients, instead of protecting the health insurance companies and letting them work the system.

If you are a medical provider or facility that feels you’ve been pressured by insurance companies to accept an unreasonable rate for your services, file your complaint with the Department of Managed Health Care by calling (888) 466-2219 https://www.dmhc.ca.gov/ or write to them at 980 9th St., #500, Sacramento, CA 95814. You can also contact the Department of Insurance at (800) 927-4357 https://www.insurance.ca.gov/ or your local political representative – who are no paid directly or indirectly by lobbyists for those private health insurance companies. You can also share your story with Truth Media or be referred for legal representation with a specialized attorney for your case against the insurance companies for illegal, coercive, unfair, fraudulent practices, bad faith, and deceptive advertisements by emailing info@truthmedia.news.

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CHỦ SỞ HỮU CỦA LEE SANDWICHES CẮT ĐỨT CÁNH TAY ĐANG LÀM THỨC ĂN CHO CHÍNH MÌNH

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Nhiều người Mỹ nhập cư đến đây để trốn khỏi đất nước đang gặp khó khăn của họ, tìm kiếm sự tự do khỏi cuộc đàn áp, hoặc để có cơ hội kinh tế tốt hơn. Đa số người Việt Nam nhập cư đến Mỹ vì tất cả những lý do này. Sau 45 năm, người Mỹ gốc Việt đang sống với giấc mơ Mỹ; họ sở hữu những ngôi nhà và cơ sở kinh doanh, có trình độ học vấn cao và họ cống hiến cho cộng đồng của họ. Nhiều người đã trở thành Công dân Hoa Kỳ, bỏ phiếu và một số thậm chí ứng cử vào văn phòng chính phủ. Nhưng khi những người Mỹ gốc Việt ăn mừng tự do của họ vào ngày 4 tháng 7 với tất cả những người Mỹ khác, thì có những người Mỹ gốc Việt sống giữa chúng tôi với tư cách là những kẻ phản bội và cộng sản.

Những người sống giữa chúng ta, sẽ không bao giờ tuyên bố mình là Cộng sản vì sợ công chúng thù địch. Nhưng với trường hợp của ông chủ Lee’s Sandwiches, ông Lê Văn Chiêu, ông có vẻ không quan tâm đến những gì người dân của mình nghĩ. Vào ngày 17 tháng 5 năm 2022, Thủ tướng Quốc gia cộng sản Việt nam, Phạm Minh Chính, đã đến thăm San Francisco và gặp gỡ Lê Văn Chiêu tại một sự kiện riêng (như hình thứ hai bên trái của bức ảnh dưới đây). Những người Mỹ gốc Việt nghe nói về điều này, đã rất phẫn nộ khi một người Mỹ rời bỏ đất nước của mình, xây dựng sự giàu có của mình trên đất Mỹ, và được rất nhiều người Mỹ ủng hộ, đã phản bội họ hết lần này đến lần khác. Khi Lê Văn Chiêu gặp Thủ tướng Nguyễn Minh Triết vào năm 2007, tại Dana Point, nhiều người Mỹ gốc Việt đã biểu tình bên ngoài cửa hàng Lee’s Sandwich của ông nhưng ông không rút ra bài học và tiếp tục đâm sau lưng những người ủng hộ mình.

Thật đáng buồn và đáng tiếc khi những tờ báo Việt Mỹ nhận tiền quảng cáo từ Lee’s Sandwiches lại chấp nhận ngậm miệng ăn tiền để không in về sự kiện ngày 17 tháng 5 năm 2022. Nếu muốn tìm kiếm sự kiện này trên Google, tất cả các bài báo đều được viết bởi các phương tiện truyền thông của Việt Nam chứ không phải ở Hoa Kỳ.

Lý do Lê Văn Chiêu liên kết với cộng sản là để họ có thể giúp ông ta vượt qua tội danh lừa dối công chúng bằng cách in trái phép nhãn USDA trên các sản phẩm của Lee’s Sandwiches. Về cơ bản, Lê Văn Chiêu đã quay lưng lại với những người đồng hương Mỹ của mình và đang nuôi dưỡng mối quan hệ của mình với những người cộng sản, chính chính phủ mà ông đã phải thoát ly. Một mặt, ông ta kiếm được của cải và tài sản của mình với những người bảo trợ Mỹ và mặt khác, ông ta đang bắt tay với cộng sản Việt Nam. Về cơ bản, ông ta đang cắn xé bàn tay nuôi sống mình và sẵn sàng phản bội đạo đức của chính mình để có được thứ ông ta muốn.

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LEE’S SANDWICHES OWNER BITES THE HAND THAT FEEDS HIM

Many immigrant Americans came here to escape their troubled countries, seeking freedom from persecution, or for better economic opportunities. A majority of Vietnamese immigrants came to America for all these reasons. After 45 years, Vietnamese Americans are now living the American dream; they own homes and businesses, are highly educated, and they give back to their community. Many have become U.S. Citizens, vote, and some even run for government office. But as Vietnamese Americans celebrate their freedom on July 4th with all other Americans, there are Vietnamese Americans living amongst us as traitors and communists.

Those who live amongst us, will never declare themselves as Communist for fear of public hostility. But in the case of Lee’s Sandwiches owner, Le Van Chieu, he seems to not care what his people think. On May 17, 2022 the Prime Minister of the Vietnamese Communist Country, Pham Minh Chinh, visited San Francisco and met with Le Van Chieu at a private event (as seen second to the left of the photo below). Vietnamese Americans who heard of this, are outraged that an American who left his country, built his wealth on American soil, and supported by so many Americans, has betrayed them over and over. When Le Van Chieu met Prime Minister Nguyen Minh Triet in 2007, in Dana Point, many Vietnamese Americans had protested and picketed outside his Lee’s Sandwich shop but he didn’t learn his lesson and continues to backstab his supporters.

It’s sad and unfortunate that Vietnamese American Newspapers that receive advertisement money from Lee’s Sandwiches accepted hush money to not print about the May 17, 2022 event. If one to were to search this event on Google, all articles are written by Vietnam’s media and not in the U.S.

Le Van Chieu’s reason for his affiliation with the communist is so that they can help him through his convicted criminal charge of deceiving the public by illegally printing USDA labels on Lee’s Sandwiches products. Basically, Le Van Chieu has turned his back on his fellow Americans and is nourishing his relationship with communists, the same government that he had to escape from. On one hand, he earned his wealth and fortune with American patrons and on the other hand he is shaking hands with Vietnamese communist. He is basically biting the hand that feeds him and is willing to betray his morals to get what he wants.

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THƯƠNG HIỆU VÀ BÁO CÁO CỦA LEE’S SANDWICHES BÂY GIỜ XUỐNG HỐ SÂU

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Ở Mỹ, khi mọi người đầu tư vào một doanh nghiệp nhượng quyền, họ đang đầu tư vào thương hiệu và danh tiếng. Tại sao mọi người muốn đầu tư vào nhượng quyền thương mại thay vì bắt đầu thương hiệu của riêng họ? Nhượng quyền thương mại thường thành công vì họ có một mô hình kinh doanh đã được thiết lập và danh tiếng tiêu chuẩn được người tiêu dùng mong đợi, trong khi việc bắt đầu kinh doanh độc quyền thường đi kèm với nhiều rủi ro hơn và ngân sách tiếp thị lớn hơn. Nhưng điều gì sẽ xảy ra khi thương hiệu nhượng quyền bị vấy bẩn từ đầu và các bên nhượng quyền không kiểm soát được danh tiếng của mình?

Ví dụ như Lee’s Sandwiches, Giám đốc điều hành Lê Văn Chiêu thường xuyên liên kết với Đảng Cộng sản Việt Nam và tham dự các sự kiện do Thủ tướng Việt Nam tổ chức. Bức ảnh chụp chung đầu tiên của ông trước công chúng với Thủ tướng Nguyễn Minh Triết vào năm 2007 đã gây ra những cuộc biểu tình đông người trước quán Lee’s Sandwiches. Các công ty nhượng quyền bắt đầu mất dần khách hàng từ những người phản đối chủ nghĩa cộng sản. Sau đó, vào năm 2021, khi Lê Văn Chiêu bị Tòa án quận Hoa Kỳ kết tội in nhãn USDA giả trên các sản phẩm Lee’s Sandwiches mà bên nhượng quyền không hề hay biết, nhiều cơ sở của nhượng quyền Lee’s Sandwiches đã ngừng kinh doanh, tìm cách bán công việc kinh doanh của họ, hoặc đấu tranh để tồn tại. Điều này gây thiệt hại cho tất cả các bên nhượng quyền, những người đã mất tiền đầu tư và sự tin tưởng của họ đối với thương hiệu.

Nhưng Lê Văn Chiêu dường như không quan tâm đến các nhà đầu tư của mình vì chỉ mới đây vào ngày 17 tháng 5 năm 2022, ông lại tham dự một sự kiện cùng với Thủ tướng Đảng Cộng sản Việt Nam, Phạm Minh Chính. Điều này dẫn đến một cuộc biểu tình rầm rộ vào ngày 6 tháng 8 năm 2022 tại Lee’s Sandwiches trên Bolsa ở Little Saigon, Westminster, California. Lê Văn Chiêu tiếp tục hủy hoại thương hiệu Lee’s Sandwiches và danh tiếng của hãng giờ đây đã đi xuống hố sâu.

Nếu bạn là người mua nhượng quyền của Lee’s Sandwiches và bạn muốn lấy lại những gì đã mất do hành động của Lê Văn Chiêu, hãy gửi email tới press@truthmedia.com. Sau 60 ngày kể từ ngày đăng này, chúng tôi sẽ tập hợp tất cả các e-mail và thông tin liên lạc của các chủ cơ sở được nhượng quyền để đề xuất với luật sư chuyên môn về bên nhận nhượng quyền. Bạn sẽ không phải trả bất kỳ khoản phí luật sư nào và bạn sẽ được bồi thường khi thắng kiện.

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LEE’S SANDWICHES’ BRAND AND REPUTATION ARE NOW DOWN THE TOILET

In America, when people invest in a franchise business, they are investing in the brand and reputation. Why do people want to invest in a franchise instead of starting their own brand? Franchises are often successful because they have an established business model and a standard reputation that is expected by the consumer, whereas starting a sole proprietorship often comes with more risk and a bigger marketing budget. But what happens when the franchise brand is tainted from the top and the franchisees have no control over their reputation?

In the instance of Lee’s Sandwiches, the CEO Le Van Chieu frequently associates himself with the Vietnamese Communist party and attends events hosted by Vietnamese Prime Ministers. His first photo together in public with Prime Minister Nguyen Minh Triet in 2007 caused protests and picketing in front of Lee’s Sandwiches. Franchisees slowly started losing customers from protestors of communism. Then in 2021, when it was discovered that Le Van Chieu was found guilty by the United States District Court for printing fake USDA labels on Lee’s Sandwiches products without the franchisees’ knowledge, many of the Lee’s Sandwiches went out of business, tried selling their business, or struggled to survive. This was devastating to all the franchisees who lost their money on their investment and their trust of the brand.

But Le Van Chieu seems to not care for his investors because only recently on May 17, 2022, he again attended an event with the Prime Minister of the Vietnamese Communist Party, Pham Minh Chinh. This resulted in a protest on August 6, 2022 at a Lee’s Sandwiches on Bolsa in Little Saigon, Westminster, California. Le Van Chieu continues to ruin Lee’s Sandwiches brand and its reputation is now down the toilet.

If you are a Lee’s Sandwiches franchisee and you want to get back what you have lost due to Le Van Chieu’s actions, email press@truthmedia.com. After 60 days from this post, we will gather all franchisees’ e-mails and the owner’s contact information to propose to an attorney specializing in franchisee. You will not have to pay any attorney’s fees and you’ll be compensated if the case is won.

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