Harvard Pilgrim Health Care said claims for the procedure—which involves a DNA analysis to determine whether a potential donor's bone marrow matches that of an individual currently on the transplant waiting list—tripled in 2009 to nearly 3,000, and they expect that number to more than triple again by the end of this year.
While significantly increasing the number of potentially life-saving donors is a good thing this by any healthcare measure, health plans are crying foul over costs they are paying for the tests, which UMass Memorial said runs between $700 and $1,500 per test, according to the Globe article. But perhaps greed got the best of UMass when it charged the health plan covering the city of Manchester, N.H., approximately $4,300 per person for the tests, which helped trigger the AG investigation.
Regardless, Quinn, CEO of marketing firm Brand=Experience, doesn't share much sympathy for Harvard Pilgrim, saying the health plan may have underestimated the number of healthy subscribers that would be persuaded to receive this voluntary, painful, expensive—and covered—service.
"While unusual spikes in any utilization causes health plans to take a closer look for fraud or abuse, absent that, covered services are covered services," she said. "And typically rates are set such that the plan sets the payment amount regardless of what is billed."
As long as there was no fraud in the solicitation and no inappropriate billing practices, which has yet to be determined, Quinn sees no problem with UMass Memorial's application of a highly successful marketing tactic. "Clearly, if I or my child or my grandchild were awaiting a match, I would be hard pressed to find harm in this approach to increasing the numbers of bone marrow registrants."