Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’

Leaders in each of those groups denied knowing who funded Doctor Patient Unity or communicating with the group directly.

“I have no idea who they are — I actually tried Google, and when you look at their website, there’s nothing,” said Michele Kimball, the president of Physicians for Fair Coverage.

Laura Wooster, a spokeswoman for the American College of Emergency Physicians, said she found the group’s first ad confusing. After learning about the group’s funders, Ms. Wooster distinguished the dark money group’s strategy from that of the college.

“ACEP does not want our proactive efforts over the past two years to help protect patients from surprise bills to be conflated with more negative messages that are perceived as obstructionist,” she said. The organization’s current president works for TeamHealth; its president elect works for Envision.

Insurance companies, which strongly favor the prevailing legislative approach, are also heavily invested in efforts to influence the surprise billing legislation, although they have been more transparent about their involvement. An industry group, the Coalition Against Surprise Medical Billing, has run digital and television ads worth several million dollars. Its latest, which ran in Washington during the Democratic presidential debate on Thursday, shows men and one woman negotiating in a dark room as a voice-over describes surprise billing as a “private equity business model.”

“Can we get a little privacy in here?” one person asks the camera.

The Doctor Patient Unity campaign is similar to other dark-money efforts in which groups try to influence public policy without disclosing donors. Anna Massoglia, a researcher at the Center for Responsive Politics, which tracks such campaigns, said many of the tactics used by Doctor Patient Unity were familiar. “You do see the same groups and the same operatives popping up time and time again as these new issues emerge,” she said.

Several lawmakers said the mysterious nature of the ad campaign had left them more committed to the issue than they were before.

“This is an example of what happens when voters can’t tell who’s paying for ads because they’re funded by dark money; it causes a lot of confusion,” Senator Jeanne Shaheen, a Democrat from New Hampshire, said in a statement. “But I don’t care how many ads they run, how many mailers they send or how much dark money they spend. I’m not intimidated and am adamant that tackling surprise billing must remain top of Congress’s to-do list.”