Dear readers,
In case you haven’t been paying attention, Focus reporter Sam Mellins has been “like a dog with a bone” (his words) with his ongoing investigation into Leading Edge Administrators. In May, the health insurance company became the default insurer for hundreds of thousands of New York’s home care workers, who care for the state’s elderly and disabled.
Sam’s reporting — the result of dozens of interviews, deep research, and poring over records — has peeled back the curtain on this little-known company and its history of shady practices. It has also put New York’s legislators and regulatory agencies on high alert, prompting them to keep a watchful eye on the company and how it treats home care workers, who are overwhelmingly women and immigrants.
I sat down with Sam to ask him a bit about what went into reporting this project, what surprised him most, and what readers should expect to see in the near future from his reporting.
Brad: How did you get started looking into Leading Edge?
Sam: As is often the case, a tip! Someone who is involved with the issue told me that I should really look into this company. I never would have found the story just trawling on my own.
Can you summarize your main findings so far for readers who haven’t been following your series?
Sure! Here are the essentials, in three short points:
Leading Edge frequently underpays doctors and leaves patients with the bills, sometimes leaving them with thousands of dollars in medical debt.
The company routinely ignores appeals from patients and doctors, sometimes hangs up in the middle of calls, and promises to pay bills but doesn’t follow through.
Lawsuits from doctors and hospitals have repeatedly accused Leading Edge of using shifty tactics to dodge costs. Many have settled for undisclosed sums.
It’s important to say that this is very much a live issue. Thousands of home health aides are now getting their coverage through this company, and some of them could be plunged into dire financial straits, or even worse, suffer serious health consequences because of treatments that Leading Edge refuses to cover.
Health insurance is notoriously complicated, and no offense, but you aren’t an expert on the topic (at least you weren’t when you started). How did you go about understanding all the ins and outs and feeling confident in your reporting?
ChatGPT. Just kidding.
One amazing privilege of being a reporter is that you are allowed to ask anyone to explain things to you, and they will often do it. For these stories, I’ve talked with policy experts, medical professionals, lawyers, and other types of sources, always asking: “Please take a look at these documents and help me understand how this company operates.”
Some of the most important people who helped with this aren’t even mentioned — but they played a critical role in making this series happen.
The half-dozen former Leading Edge employees I spoke to were also invaluable. I’d obtained documents that planted various theories and suspicions in my brain, but it wasn’t until the former employees broke down for me how the company operates that I was able to confirm many of them.
What has surprised you most while reporting this series?
This document. I encountered it as I was plowing through the dockets of every federal lawsuit against Leading Edge. My jaw literally dropped when I read it for the first time.
Though it doesn’t make this accusation explicitly, it essentially implies that Leading Edge and a union’s benefit fund that worked with it forged a backdated document retroactively canceling a patient’s insurance in an attempt to get out of paying for the patient’s months-long hospital stay.
The union fund only abandoned its attempt to cancel the patient’s insurance when the hospital threatened to report the matter to government regulators.
Not to give away too much, but we’ve got more in the works on this topic. Why, personally, do you want to continue reporting on Leading Edge?
We’ve already seen results from this reporting — after we asked Leading Edge about the case of Robyn Hodgson (a Pennsylvania woman with thousands of dollars in medical debts due to treatments that Leading Edge has refused to cover), the company paid over a dozen of her bills that it had previously said were her responsibility.
And personally, I want to understand this company and how it operates. The reporting I’ve done so far has only captured some aspects of their business. There are entire categories of services Leading Edge provides that I haven’t even touched on, and am still trying to learn more about.
When I come upon a topic like this, with so many facets and different parts, I try to be like a dog with a bone. I don’t want to let go while there’s still any meat on it.
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