UBiome is facing a pretty serious investigation

Know there have been threads on some of this, but this escalated today. https://www.cnbc.com/2019/04/26/the-fbi-just-raided-ubiomes-office-for-billing-practices.html

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I found the news reports confusing. There was reference to “double billing insurers” but I didn’t think that uBiome tests were covered by insurance - are they?

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I’m sure there’s more to come after the FBI investigation - but as I understand it, there are a number of BBB complaints about insurance billing, insurers rejecting bills, and unexpected bills. The uBiome site describes their “SmartGut” and “SmartJane” products as “an insurance-reimbursed test ordered by a healthcare provider. uBiome clinical tests are fully or partially covered by most health insurance companies under ‘out-of-network’ healthcare benefits. We have patient assistance programs in place to assist eligible patients with the remaining patient responsibility.” Apparently (per the BBB complaints - I don’t know about the FBI investigation) some bills to insurers for a single test were as much as $2,900+, and some insurers were double-billed for a single test. The review website highya.com (in 2017) showed that single tests for individuals were in the $100 - $300 range, including uBiome’s direct-to-consumer beta product (at $399).

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And - there are two sides to this story - perhaps details will emerge that show no wrongdoing. I’ll be interested to see the company’s response.

There’s got to be a pretty deep backstory, I would definitely like to know both sides. I read in WSJ that uBiome raised 83 million in investment. I think of them as a relatively small, avant-garde toolmaker, and my interactions with them have always been about the science of microbiome analysis, a topic on which their staff and collaborators have been extremely well informed. But investments at this scale typically go along with aggressive business approaches; will be following closely.

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I did the SmartGut test last year, after uBiome contacted me to ask if I wanted to do it, and that they’d bill my health insurance, but would cover any costs not reimbursed. Couldn’t say no to such an offer :slight_smile:

Turns out they billed my health insurance ~$3K (!) for the test. While my health insurance didn’t reimburse (no surprise there), this put me over my out-of-pocket maximum (don’t ask, US healthcare weirdness), so I ended up with a check for over $100…

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I’m pretty sure that’s illegal. (For them, not you.)

Not necessarily, as they had a doctor order the test, and while that doctor is paid by uBiome for each test they prescribe, I wouldn’t be surprised to learn that such a blatant conflict of interest is in fact very legal :see_no_evil:

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The double billing is only half of the issue. The other issue is that the tests have a very high false alarm rate but they are marketing them as if they are clinically usable. I don’t believe insurance companies have the understanding to know such a thing (or they wouldnt have reimbursed for them). I’d be happy to talk more about this, but not in a public forum.

“Aggressive business practices” are the least worrying part of uBiome’s backstory. They’ll make a great case study for how the Quantified Self community was better at spotting problems than the professional scientists who lent them so much undeserved credibility.

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Since Richard is definitely person I’m most likely to take seriously on this topic, I’m interested in hearing more, if it’s something shareable here in public.

Worthy of a longer conversation when I get time. Meanwhile, my Twitter summary (and the comments): https://twitter.com/sprague/status/1124358304677810176

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Very important thread.

A good video on how these “Smart” reports go bad.

I work in healthcare claims and payments and I think (don’t quote me) that you’re right @ejain, but nevertheless, most people at insurance companies would think twice before reimbursing this.

The fortunate (or unfortunate, depending on your perspective) part of what uBiome did is that they assumed that they could get some insurance companies to pay without a second glance because of automated systems. I think the biggest insurance company in the country (starts with a U) has a 90+% automatic processing rate.