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Before you get in that wheelchair, how about you fill out some forms? Photo: Michael Stravato/For the Washington Post via Getty Images

Health care's administrative back end — services like verifying patients' insurance, putting patients on payment plans and collecting patient debt — is bigger than ever.

The big picture: The U.S.' fractured insurance system leads hospitals and doctors to spend tens of billions of dollars annually on billing software and services — none of which are tied to actual health care.

Driving the news: For-profit hospital system Tenet Healthcare decided to spin off its billing services unit, Conifer, into its own publicly traded entity in 2021.

Between the lines: Conifer and hundreds of other companies sell their administrative services at a profitable rate. And many hospital systems that send out the bills have ownership stakes in these companies.

  • Tenet controls 76% of Conifer, which registered $1.5 billion of revenue last year. Catholic Health Initiatives owns the remaining 24%. They both use Conifer.
  • Catholic health system Ascension and private equity firm TowerBrook hold a majority stake in R1 RCM, which used to be named Accretive Health and was prohibited from doing business in Minnesota due to its aggressive collections practices. Two Ascension executives sit on R1's board.
  • Bon Secours Mercy Health recently sold off a majority stake in its billing firm, Ensemble Health Partners, for $1.2 billion, the Wall Street Journal reported.

The bottom line: Researchers have cited administrative costs as a sizable source of health care waste. Some startups are trying to address this issue, but traditional billing and service firms are only getting larger and have providers as investors.

Go deeper

New York AG finds Cuomo sexually harassed women, violated state and federal law

Photo: Spencer Platt/Getty Images

An independent investigation found that New York Gov. Andrew Cuomo sexually harassed multiple women, including employees in his office, in violation of state and federal law, New York Attorney General Letitia James announced Tuesday.

Why it matters: Cuomo, who has denied wrongdoing and urged critics to wait for the results of the independent inquiry, will now face renewed pressure to resign. He must also determine whether he will continue his 2022 re-election campaign.

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New York City to require vaccination proof for indoor activities

New York City will require proof of vaccination to participate in indoor activities, including visiting gyms and restaurants, Mayor Bill de Blasio announced Tuesday.

Why it matters: The mandate is the first of its kind for a major U.S. city, according to de Blasio. France and Italy announced similar requirements last month.

Updated 2 hours ago - Economy & Business

Exclusive: Facebook's first-ever paid movie premiere

Illustration: Aïda Amer/Axios

For the first time ever, a film distributor will use Facebook to debut a movie exclusively via a ticketed live event, executives tell Axios.

Driving the news: "The Outsider," a controversial documentary about the construction of the 9/11 Museum in Manhattan, will premiere publicly on Facebook for $3.99 on Aug. 19.