The lobbist who hijacked ~3% of revenue from US doctors | Hacker News Reader

The lobbist who hijacked ~3% of revenue from US doctors

propublica.org

but that it amounted to a new rule that should have been issued via the formal rulemaking process

This is the key part. New regulations need to be made public, a period for public comment is then opened, then comments are made available, then revised regulation is made public before it goes into effect. It takes a good part of a year.

CMS can't just interpret their own regulations however they like. Nor can they make quick updates.

What it sounds like here is the original regulations were badly written ("direct" payments). Zeilis knew it and challenged it, so CMS backed down rather than fight a battle it knew it would lose in the end.

It's similar to prior comments about companies exploiting bad laws or regulations - it's up to the regulator or Congress to fix it - they were the ones who broke it. This seems like a fantastic opportunity for Congress to pass a single law banning fees above normal costs for ACH transfers. Easy win, vote on it before a weekend.

But we know Congress won't.

I think they would if there was public awareness. Most people reading this article likely didn't even know this was an issue.

I know because people in healthcare don't even know this is an issue

For congress, its out of sight, out of mind. But this would be a very easy win. Look at the CEO getting murdered and everyone one kind of being OK with it. Insurance is ripe for disruption.

My wife's practice is directly affected by this, the fees insurers charge her to receive money from them are crazy. Some insurers will only pay her in a debit style card that they then charge her an extra percentage fee for receiving.

You can actually reject the VCC, if you call, and request a check. You may need to do it a few times before it sticks.

Some insurers yes (and even then it takes several tries), but at least one has said outright no.

https://news.ycombinator.com/item?id=37129568 - Aug 2023 (10 comments)

https://news.ycombinator.com/item?id=37122404 - Aug 2023 (2 comments)

Probably the best in-depth investigation I've read from Propublica. Well done.

This is also one of those rare stories that can be pinned down on 1 particularly sleazy actor

It takes more than one person to monopolize a vital medical insurance function and then wage a dubious legal war against government regulation to reap an unearned middleman tax.

Reply on news.ycombinator.com