a stat investigation
How did this Texas couple get rich off out-of-network medical bills?
Molly Ferguson for STAT
The short answer: In a new system designed to make health care more affordable for patients, a little-known middleman called HaloMD uses a tactic that is possibly even more lucrative for providers than surprise billing was.
The long answer begins at a party in Las Vegas, where a recently divorced woman met a health care entrepreneur. About a decade later, the now-married LaRoque duo formed HaloMD, which helps providers navigate the federal arbitration process to resolve billing disputes with insurance companies. But according to lawsuits against the company, HaloMD takes advantage of the overburdened system to cash in on disputes that often shouldn’t even be considered eligible. It’s not the only company taking this approach, but it is by far the biggest.
“Overall, I don’t think they’re bad people,” said one surgeon who used to work with the couple’s other health care company. “Now, are they going to do whatever they can to make as much money as they can? Absolutely yes.”
Read more from STAT’s Tara Bannow, who reviewed thousands of pages of court filings and company documents, and interviewed more than 50 people. I promise, you can’t even begin to imagine how juicy a story about a process called “independent dispute resolution” can get.
addiction
Kratom use trends in one hospital system
The kratom plant has been incorporated into herbal medicine for centuries, and recently became popular in the U.S. for recreational use or as a pain treatment. A study published yesterday in JAMA Network Open aimed to quantify this trend by analyzing electronic health records from one Boston-based hospital system.
Between 2017 and 2024, hospitalizations where kratom is mentioned in clinical notes increased significantly, with an average increase of 15% per year. Mentions of kratom also increased for emergency department visits, though not significantly. (Overall, mentions increased from less than 500 in 2017 to nearly 1,500 in 2024.)
As kratom use increases, it’s unclear what the best regulatory approach may be. Kratom itself is not a significant source of overdose deaths, and there are no recorded instances of a fatal overdose involving only 7-OH without any other substance.
Last summer, the FDA recommended that 7-OH, a psychoactive compound derived from the plant, be added to the schedule of controlled substances. A handful of states have banned it. In California, the public health department recently seized $5 million in products, a move justified by an existing law allowing officials to seize products that aren’t federally or state approved. In Kansas, legislators are considering a bill to criminalize kratom and 7-OH products. But as overdose deaths involving fentanyl continue, some argue that criminalizing a safer alternative will only make things worse.
one small number
9.9%
That’s the cigarette smoking rate among U.S. adults in 2024 — the lowest in recorded history. As STAT’s Sarah Todd reports, the number is a big deal in itself. But what’s also remarkable is how everyone is finding out. Usually the federal government would report the data it had collected. But instead, the news came through outside analysis produced by researchers and published in NEJM Evidence.
“In public health, the number 10% is very symbolic to us,” said Israel Agaku, who authored the analysis. “Things below 10% are considered rare events or unusual events.” Read more on the milestone and what it means for public health.
