Cyberattack Cripples U.S. Healthcare System

"Why Aren't My Claims Getting Paid?"

By Christopher Lim

June 25, 2024

Healthcare providers across the United States are struggling to keep the lights on following a ransomware attack on the largest healthcare clearinghouse in the country. The attack in late February 2024 caused a mass shutdown of the electronic billing and payment system maintained by Change Healthcare, a subsidiary of UnitedHealth Group. Several thousands of healthcare providers have since been unable to obtain insurance approvals for medical services and prescription drugs.

Change Healthcare serves as a clearinghouse for major U.S. health insurance companies. The service allows insurance companies to process the staggering volume

of healthcare claims filed by healthcare providers each day. While insurance companies historically managed these requests internally, there has been an increasing practice of outsourcing the job to Change Healthcare. As a result, insurance companies have pulled funding away from their claim-processing departments, withering away their ability to shoulder the load of requests that continues to mount. Unfortunately, Change Healthcare presently holds a near-monopoly on healthcare billing services, leaving insurance companies with few alternatives. Due to this bottleneck in the pipeline of insurance payment processing, a systemwide failure was inevitable.

Lawmakers are just now waking up to the unmitigated danger created by healthcare conglomerates such as UnitedHealth Group. Although temporary workarounds have been implemented, the damage to the healthcare system is already done, and many providers have been forced to shutter their clinics. Solo practitioners and small provider groups have been particularly affected by the Change Healthcare catastrophe. Most concerning, however, is the harm inflicted on patients who rely on their insurance benefits to access critical services. With insurance companies unable to process claims, many providers can no longer afford to accept insurance, which means that patients are resigned to paying for services out of their own pockets. Meanwhile, insurance companies continue to collect monthly premiums from patients who cannot enjoy the benefits of their insurance policies.

For providers, choosing to accept insurance is risky, but it can also serve as the bread and butter of a successful practice. Providers who are looking to grow their own practices should familiarize themselves with the insurance industry and keep abreast of major changes.