Auditors praise Trump anti-fraud healthcare proposal

A coalition of 14 state financial leaders across the country backed a Trump administration policy to reduce fraud in health-care systems. The group of state financial officers wrote a letter Wednesday to the Trump administration praising a policy from the U.S. Department of Labor that requested greater transparency from health-care providers in the country. The rule would require pharmacy benefit managers to disclose where they receive funding and rein in group health care plan costs. "Disclosure of PBM compensation is essential for plan fiduciaries to identify conflicts of interest and satisfy their duty to evaluate the reasonableness of plan expenditures and service provider fees," the officials wrote. The financial officers have previously called for transparency from health-care providers. The officials accused large corporations of overcharging for health care and dramatically raised the price of employer health plans. The officers said the proposed rule would prevent pharmacy benefit managers from charging vastly different prices for the same drug. Three PBMs – OptumRx, CVS Caremark and Express Scripts – manage 79% of prescription drug claims, according to the report. The proposed rule also prohibits PBMs from restricting audits on its activities. The officials praised this addition and said it will bring needed accountability to the health-care system. Still, the auditors called for the department to clarify that providers should include access to underlying claims and payment data as part of its process. While the authors of the letter praised much of the administration's rule changes, they called on it to go further in its implementation of health-care price transparency. The letter called for regulators to expand accountability beyond PBMs and require insurers to follow the same steps as well. The officials also requested administrators consider requiring disclosure of transaction-level claims and pricing data so it can be verified against withdrawals from plan assets. "Require semi-annual disclosures of per-transaction claims and pricing data, including in-network rates, allowed amounts, and amounts actually paid to providers," the report reads. OJ Oleka, CEO of the State Financial Officers Foundation, praised the Trump administration for moving forward with the policy. "This transparency is essential to safeguarding taxpayer resources and fulfilling fiduciary responsibilities," Oleka said. "Transparency isn't just about accountability; it's critical to detecting waste, preventing fraud, and ensuring that healthcare spending delivers value to the workers, businesses, and taxpayers who ultimately bear these costs." Pennsylvania Auditor General Tim DeFoor, Louisiana Treasurer John Fleming, South Carolina Treasurer Curtis Loftis and Utah Auditor Tina Cannon were among the 14 financial officers who cosigned the letter. "Greater oversight and accountability for employer-based health plans will help prevent waste, fraud, and abuse in federal healthcare programs," Cannon said. "Expanding this rule would help us do our jobs, root out fraud and waste, and reduce the cost of healthcare for all Americans."