Your Plan, Your People, Your Responsibility

Lessons from an Insurer’s Corporate Spy Operation

Every now and then, I sit with an employer who says they want to keep their distance from their employees’ healthcare decisions — to avoid getting too close to claims or medical situations. I get it. The instinct is understandable.

But the problem is, this trust is misplaced. Stories like the one you're about to read pop up constantly in our industry. Wall Street and private equity-driven companies — the same companies running these carriers — are ruthlessly committed to one thing: protecting their profits. If that means delaying care, denying claims, or even spying on lawmakers and patients to preserve sweetheart government contracts, so be it.

If you think Carrier X is going to manage your employees’ health needs better than an independent TPA with a fairly written, member-protective Summary Plan Description — you need to read what happened here.

When employers self-fund thoughtfully, with the right partners, they build plans designed to help and heal their teams. When they outsource it to profit-maximizers like this? Well... you can guess who wins, and it’s not your employees.

Take a good look at this case. And then decide what kind of healthcare system you want to be a part of.

The original story appeared in the Dallas Morning News.

Centene’s Texas Spy Ring: How to Torch Your Credibility in One Simple Hearing

In a story so greasy it practically slid out of the Texas Capitol, the CEO of Superior HealthPlan — a Centene company (most commonly known as Health Net in California) — got himself fired after admitting, under oath, that he hired private investigators to dig up dirt on lawmakers, providers, patients, and even journalists.

Yes. A taxpayer-funded health plan spying on the people it's supposed to serve. You can't make this stuff up.

During a heated Texas House hearing on Medicaid procurement, CEO Mark Sanders fessed up: beginning in 2017, Superior ran background checks, pulled divorce records, snapped photos of homes, and ran credit checks — all on the public’s dime. He called it “routine research.” Lawmakers called it exactly what it was: surveillance.

State Rep. Giovanni Capriglione, one of the targets, nailed the core issue when he asked why on earth a healthcare company would stalk sick kids’ parents just to save a buck. Sanders, looking like he'd swallowed a lemon, gave the sort of vague, deflective answer you’d expect from someone who knows exactly how bad this looks.

Texas Attorney General Ken Paxton wasted no time, launching a formal investigation. Why? Because the accusations are as ugly as it gets: surveillance used to blackmail lawmakers into awarding juicy state contracts, and targeting families trying to get lifesaving care.

Documents later revealed that Superior's surveillance net wasn’t small: it swept up lawmakers, reporters, sick patients, healthcare providers — basically anyone who might cost Centene a nickel. Even a reporter from The Dallas Morning News who had the nerve to uncover the company’s dirty laundry found himself under the microscope.

The timing wasn’t random, either. Superior faced lawsuits over care denials and was desperately trying to hang onto a fat $116 billion Medicaid overhaul. Sanders’ unleashed his crack team of private eyes just as the company was at risk of losing nearly $900 billion in future contracts. Coincidence? Sure — and balance billing patients into bankruptcy is just a harmless misunderstanding too.

Lawmakers were rightfully furious. New legislation is now moving forward to ban any company from ever landing a state contract again if they pull stunts like this.

Centene tried to wash its hands clean with a carefully worded statement claiming this isn’t “reflective of our values.” Funny — it was reflective enough to happen repeatedly over several years while billions were on the line.

Bottom line? Superior HealthPlan didn’t just screw up. They betrayed the trust placed in them to manage taxpayer dollars and care for the most vulnerable Texans. They gamed the system, weaponized surveillance, and chased profits at the direct expense of the people they were supposed to protect.

Employers who still believe massive carriers operate with their employees' best interests at heart need to sit with this story for a while. Really sit with it.