Michigan Patient Protection Plan
A Denial Code Is Not a License to Kill
When a knowing or reckless denial causes catastrophic injury or death, Michigan should follow the decision from the algorithm to the human beings and corporate policies behind it.
The Michigan Patient Protection & Corporate Accountability Plan
Medicine, Not Denial Codes
Health care should be governed by medicine, patient consent, and the value of human life — not anonymous denial systems, monopoly power, hidden markups, or corporate incentives that reward delaying treatment.
An insurance denial is not automatically a crime. But paperwork is not automatic immunity from criminal law either.
When a decision-maker is warned that denying or delaying treatment creates a substantial risk of death or irreversible injury, has the authority to prevent that harm, rejects medically necessary covered care without a reasonable clinical or legal basis, and the patient dies because of that decision, the case should not be dismissed as a billing dispute.
It should be investigated as a potentially criminal act.
As Attorney General, I will use every lawful power of the office to expose health-care fraud, corporate deception, monopoly conduct, abusive hospital practices, unlawful denials, and the financial incentives behind them. Where current law is inadequate, I will put specific legislation before the people and the Legislature.
The Basic Rule
Doctors document. Patients choose. Insurers explain. Human beings remain accountable.
No insurance company should be allowed to hide a life-and-death decision behind an algorithm, an anonymous committee, a third-party contractor, or a corporate shell. No executive should be rewarded for creating an unlawful denial system and then claim that no individual person made the decision. No patient should need a lawyer, a public campaign, or a viral fundraiser to receive urgent care that their medical team has already determined is necessary.
Day One
What I Will Do Without Waiting for New Legislation
Establish the Patient Protection & Corporate Accountability Initiative
Michigan’s Attorney General already has civil enforcement responsibilities involving antitrust, consumer protection, and charitable trusts. The office’s Health Care Fraud Division investigates and prosecutes Medicaid provider fraud and abuse or neglect in residential care facilities. The Department of Insurance and Financial Services (DIFS) regulates insurance and administers Michigan’s external-review process for eligible health-insurance denials. I will connect those existing lanes through a formal, interdivisional health-care accountability initiative.
When a family reports death, catastrophic injury, permanent disability, organ loss, paralysis, or another irreversible outcome following an urgent denial, the state will no longer treat that complaint as ordinary customer-service correspondence. The initiative will:
- Preserve denial records, communications, clinical warnings, internal criteria, algorithmic recommendations, and audit trails where legal authority permits.
- Identify the people and companies that designed, authorized, implemented, or maintained the denial.
- Determine whether similar denials affected additional patients.
- Investigate evidence of deception, fraudulent representations, obstruction, unlawful financial incentives, anticompetitive conduct, or destruction of evidence.
- Coordinate with DIFS, county prosecutors, licensing authorities, and federal agencies rather than bouncing families from office to office.
- Refer or prosecute cases under the laws and jurisdiction supported by the evidence.
There will be no presumption of guilt. There will also be no presumption that a corporation is innocent merely because the harm was delivered electronically.
Follow the Decision All the Way to the Top
Every serious investigation will ask: Who received the treating physician’s warning? Who had authority to approve the care? What clinical criteria were actually applied, and were they part of the patient’s contract? Did a qualified specialist review the case? Did an algorithm recommend the denial, and could a human override it? Was anyone compensated, evaluated, or promoted based on reduced spending or denial rates? Did an executive create a policy that made wrongful denials predictable — and continue it after being warned that patients were being harmed?
A corporate title will not automatically establish criminal responsibility. But it will not erase responsibility where the evidence establishes knowing participation, reckless supervision, concealment, or intentional maintenance of a dangerous policy.
Investigate Patterns, Not Just Individual Complaints
One denied claim can be explained away as an error. Hundreds of similar denials may reveal a business practice. My office will build the capacity to identify patterns involving repeated denials of the same treatment, fabricated or undisclosed coverage criteria, inaccurate provider directories, automatic denial systems, retaliation against physicians who appeal, delays that routinely exceed legal deadlines, post-denial alteration of records, financial targets connected to denial volume, and contractors used to conceal who actually made the decision. We will publish insurer-specific aggregate findings when legally permissible, while protecting patients’ private medical information.
Attack Health-Care Monopoly Power
The Attorney General’s existing corporate-oversight responsibilities include antitrust, consumer-protection, and charitable-trust enforcement, and Michigan’s Antitrust Reform Act provides investigative and enforcement mechanisms for restraints of trade. My office will aggressively examine hospital mergers that eliminate local competition, hospital systems buying independent practices and then raising prices, exclusive contracts that lock out lower-cost providers, pharmacy-benefit practices that conceal rebates and spreads, arrangements that steer patients toward corporate affiliates without disclosure, private-equity structures that extract money while cutting staffing, and agreements that prevent doctors and nurses from speaking honestly about patient safety.
Private ownership is not the same thing as a private license to corner a market and hold patients hostage.
Hold Nonprofit Hospitals to Their Public Mission
A nonprofit hospital should not act like a charity when requesting tax advantages and like a collection agency when dealing with a patient who cannot pay. Using the Attorney General’s charitable-oversight authority, my office will scrutinize charity-care denials, collection lawsuits against low-income patients, property liens, facility fees, executive compensation, related-party transactions, transfers of money to parent organizations, hospital conversions and sales, and whether promised community investments were actually made. A hospital that receives charitable treatment must be able to demonstrate charitable conduct.
The Legislative Package
The Patient Life Protection & Insurer Accountability Act
The Attorney General cannot create new crimes or rewrite insurance law by executive order. I will therefore submit and publicly advocate for a comprehensive legislative package.
A Carefully Defined Criminal Offense
The act will create an offense for the reckless deprivation of urgently necessary care. The prosecution would be required to prove that:
- The defendant had actual authority or a defined legal, contractual, or professional responsibility concerning access to the care.
- The defendant received documented notice that denial or delay created a substantial risk of death or irreversible serious injury.
- The requested care was covered, or the defendant knowingly misrepresented the coverage.
- The defendant knowingly or recklessly denied or delayed the care without a reasonable medical or legal basis.
- The decision caused death or serious bodily harm.
This would not make every mistaken denial a felony. It would not create guilt based solely on someone’s job title. It would not eliminate due process or lower the government’s burden of proof. It establishes one principle:
Control over another person’s access to life-preserving treatment carries responsibility for the knowing or reckless abuse of that control.
Two-Hour Protection for Imminent Medical Emergencies
Michigan law currently treats an urgent prior-authorization request certified by a provider as granted when an insurer fails to act within 72 hours. For a patient facing organ failure, paralysis, permanent neurological damage, loss of a limb, or death, 72 hours may still be far too long. The new imminent-risk category will require a decision within two hours when a treating clinician certifies an immediate risk of death or irreversible harm; provisional coverage while emergency review is pending; a direct treating-physician override when waiting would itself be dangerous; immediate independent review by a qualified specialist; an emergency judicial and administrative review process available around the clock; and automatic preservation of all records related to the decision.
No More Anonymous Final Denials
A final denial involving a serious risk to life or health must identify the responsible human reviewer, their license and specialty, the specific policy language relied upon, the clinical criteria applied, the medical evidence considered and any evidence excluded (and why), the role of any algorithm or vendor, and every person who directed, approved, or materially altered the determination.
A computer may assist with information. It may not become a legal fiction used to ensure that nobody is responsible.
End Denial Quotas and Dangerous Financial Incentives
The act will prohibit compensation structures that reward employees, contractors, medical directors, or executives for making wrongful denials or maintaining unlawful denial rates, and will require disclosure of performance measurements tied to medical-spending reductions, approval rates, appeal outcomes, treatment delays, and denial volume. Saving money through efficiency is legitimate. Saving money by knowingly blocking covered, medically necessary care is not.
Protect Medical Whistleblowers
Doctors, nurses, pharmacists, claims employees, data analysts, and contractors must be able to report dangerous practices without losing their jobs, contracts, licenses, or professional standing. The law will prohibit retaliation against people who disclose predetermined denial quotas, manipulated clinical criteria, false medical-record statements, algorithmic defects, concealed patient injuries or deaths, orders to destroy records, or corporate policies that place patients in foreseeable danger.
Make the Financial Consequences Larger Than the Profit
A fine that costs less than the money generated by unlawful conduct becomes a business expense. The act will authorize meaningful remedies: restitution; wrongful-death and survival damages; statutory and enhanced damages for knowing violations; attorney fees; disgorgement of savings or profits from unlawful denials; civil penalties for each affected patient and each day of unlawful delay; executive-compensation clawbacks where knowing participation is proven; suspension from public contracts; independent compliance monitoring; and license consequences for repeated or intentional misconduct.
Price & Transparency
End the “Medical-Grade” Price Game
The words “medical grade” should never be treated as a blank check. At the same time, cheaper does not automatically mean clinically interchangeable — sterility, calibration, biocompatibility, durability, traceability, electrical safety, accuracy, and failure rates can matter enormously. My plan is not to tell hospitals to substitute random consumer products for critical equipment. My plan is to find out what we are actually paying for.
Michigan Medical Product Price & Equivalency Project
Working with clinicians, engineers, independent laboratories, universities, purchasing professionals, and appropriate regulators, Michigan will compare high-priced medical products with lower-cost alternatives — examining materials, intended use, sterility controls, accuracy and calibration, electrical and mechanical safety, durability, biocompatibility, failure rates, warranty and servicing, traceability and recall procedures, applicable federal requirements, and the actual clinical consequences of product failure.
When two products are genuinely equivalent for a defined use, public purchasers should not be forced to buy the one carrying the largest artificial markup. When they are not equivalent, the state should explain the safety difference in plain language. We will not gamble with implants, sterile invasive devices, diagnostic accuracy, or life-support systems — and we will not accept “medical grade” as the sole explanation for charging taxpayers ten, twenty, or fifty times more.
Show the Public the Real Price
Federal hospital-price-transparency rules require hospitals to publish extensive pricing information, including machine-readable files, with updated requirements taking effect in 2026. The data exist, but they are often difficult for ordinary patients to compare. I will advocate for a Michigan True Medical Price Portal that lets the public search by procedure, location, hospital, insurer, and cash-pay status — showing cash prices, negotiated insurance prices, facility fees, professional fees, public-program benchmarks, typical regional prices, lower-cost nearby options, and whether required information is missing.
People should not have to undergo a procedure before being allowed to learn what it costs.
Private Choice Without Private Impunity
I am not promising to seize every private insurance company. I support creating a transparent, nonprofit public insurance option that competes alongside private plans — its surplus going toward patient care, lower premiums, reserves, or expanded benefits, not executive bonuses tied to denying treatment. Private insurers may continue operating. They will simply have to compete against an option that is not designed primarily to extract profit from illness. That is not an attack on choice. That is the creation of an actual choice.
Guardrails
What This Plan Does Not Mean
Not every denial is murder
A criminal case requires evidence of duty, knowledge, culpable intent or recklessness, causation, and individual responsibility. The government must prove every required element.
Not every price is a scam
Some products cost more because they meet legitimate safety, testing, sterilization, or regulatory requirements. We will identify those differences rather than accepting marketing language as proof.
The AG doesn’t replace doctors
Medical decisions remain medical decisions, and insurance regulation remains coordinated with DIFS. The Attorney General enforces the law, investigates misconduct, protects consumers, and prosecutes within the office’s jurisdiction.
Corporations answer for consequences
A decision made in an office instead of on a street does not make the injury imaginary. Harm through delay instead of force does not make the patient less dead.
Sources
Where the Authority Comes From
- Michigan AG — Corporate Oversight Division (antitrust, consumer protection, charitable trusts)
- Michigan AG — Health Care Fraud Division
- Michigan DIFS — Health Insurance Consumer Information
- Michigan Antitrust Reform Act (PA 274 of 1984)
- Michigan AG — Charitable Trust / Nonprofit Oversight
- MCL 500.2212e — Prior Authorization Requirements
- FDA — Classify Your Medical Device
- CMS — Hospital Price Transparency