Highmark Takes on Outpatient Markups

Highmark, an insurer with its own health system, is challenging a growing and controversial billing practice that also happens to be a central part of some health system integration strategies.

Highmark, an insurer with its own health system, is challenging a growing and controversial billing practice that also happens to be a central part of some health system integration strategies.

Around August 2010, a lawsuit filed by Highmark contends, University of Pittsburgh Medical Centers hospitals and physician groups started charging “significantly higher prices for oncology drugs and related oncology services,” without any changes in treatment settings or outcomes.

Since then, Highmark alleges that it has been overcharged some $300 million. The cost of oncology drugs has tripled in the ensuing four years, the company argues, as office-based treatment has been billed as hospital outpatient services.

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Source: Healthcare Payer News