• Grassroots EM

Conflict of Interest in Pivotal Surprise Billing "study"

On August 10, 2021 an earth-shattering article was published in The Intercept by Rose Adams, "UnitedHealthcare Guided Yale's Groundbreaking Surprise Billing Study". The "study" was from none other than Yale Professor and Surprise Billing policy profiteer, Dr. Zack Cooper. Dr. Cooper's paper was based on a single source of payer data from United HealthCare's (UHC) and UHC executives served as editor and held veto power over publication. If UHC executives did not like the conclusions - the study would not be published.

Dr. Cooper never shared his conflict of interest with NBER, the New England Journal of Medicine (NEJM), journalists or any of the Congressional legislators who quoted him and his paper. Instead, Dr. Cooper portrayed himself as an independent investigator. His article, "Out-of-Network Emergency-Physician Bills — An Unwelcome Surprise", critically influenced the Federal legislation developed to address Surprise Billing and was cited numerous times in Congressional Hearings, Briefings, and ultimately the No Surprises Act itself. Further, the study been referenced over 10 times in the Interim Final Rule for the No Surprises Act published by the Tri-Departments (HHS, DOL, and US Treasury) this summer.

Dr. Cooper's COI has long been suspected by physicians and patient advocacy groups following the development of Surprise Billing legislation, as he has received multiple grants and awards from NIHCM, a non-profit front for some of the largest health insurers to fund pro-insurer research, and has incessantly advocated for health insurers' interests on issues.

Rose Adam's article finally exposed the truth. Validation is not enough.

The Tri-Departments are actively developing the No Surprises Act Rules & Regulations.

What can you do?

1. Write/Call/Tweet your elected officials and make them aware of this severe COI that drove legislation in insurers' favor. Ask them to investigate UHC and other mega health insurer's role in skewing the legislation with tainted research and behind-the-scenes deal. Check out our advocacy tools page to locate your legislators.

2. Contact the Tri-Departments: HHS, Department of Labor, and the US Treasury Secretaries and let them know this bias must be considered when writing the Rules & Regs for the No Surprises Act.

3. Comment on the Interim Final Rule for the No Surprises Act. You can submit a Formal Comment on the current rule on the Federal Register's site. Comments for the IFR are due September 13, 2021.

4. Write to the NEJM at and request they review and retract the study. Take a look at our draft here.

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