Clover Health CEO Vivek Garipalli addressed the insurer's controversial history for the first time in an interview with Yahoo News.
Criticism of Mr. Garipalli dates back to 2013, when hospitals he owned in New Jersey saw high billing rates, according to the July 19 interview. In 2019, state officials uncovered shell companies that charged $157 million in management fees to the hospital, leading to improved transparency laws and speculation toward Mr. Garipalli.
However, the investigation yielded no apparent wrongdoing.
Mr. Garipalli responded to critics, claiming his approach aimed to preserve the hospitals, which served urban communities. Instead, he pointed to the payer mix — the blend of Medicare, Medicaid and private insurer payments — as putting strain on hospital systems.
His use of cost-shifting — where private insurers make up income gaps left by poor profit margins on Medicare and Medicaid patients — was a result of the hospitals seeing vastly more underserved, and therefore Medicaid/Medicare-eligible, patients. However, those underserved populations need more representation, Mr. Garipalli said.
"There is no lobbying voice for Medicaid patients, there's no lobbying voice for those who are uninsured, there's no lobbying voice for undocumented immigrants who seek out health care services," Mr. Garipalli said. "They tend to live in a lot of those markets, and hospitals are required to (by law) see everyone in the emergency room, even if [a patient] is undocumented."