NY attorney general plans to sue payers
Manipulation of rates charged
Andrew Cuomo, the New York state attorney general, is going to sue UnitedHealth Group and four of its subsidiaries, including Ingenix, on allegations that they defrauding consumers by manipulating reimbursement rates, according to the American Hospital Association (AHA). Cuomo alleges that Ingenix "serves as a conduit for rigged data to the largest insurers in the country." Which payers use to set reimbursement rates for out-of-network medical expenses, the AHA says.
Daniel Sisto, president of the Healthcare Association of New York State, said in a prepared statement, "If the attorney general's allegations are proven true, we believe that United and Ingenix's practices have cheated the entire health care provider community by artificially lowering reimbursement for the services they provided."
As part of the investigation, several large insurers in New York have been subpoenaed by Cuomo, including Aetna, Cigna, Empire BlueCross BlueShield, and other insurers, according to the AHA.
Cuomo's investigation found that two subsidiaries of United dramatically underreimbursed their members for out-of-network medical expenses by using data provided by Ingenix. The United insurers and many other health insurance companies relied on the Ingenix database to determine their "reasonable and customary" rates. Cuomo's investigation found that by distorting the "reasonable and customary" rate, the United subsidiaries were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs.
"Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is," Cuomo said in a prepared statement. "But when insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need."
When members complained their medical costs were unfairly high, the United insurers hid their connection to Ingenix by claiming the rate was the product of "independent research," according to Cuomo. His notice to United expressed concern that the company's ownership of Ingenix created a clear conflict of interest because their relationship gave Ingenix an incentive to set rates that benefited United and its subsidiaries.
Andrew Cuomo, the New York state attorney general, is going to sue UnitedHealth Group and four of its subsidiaries, including Ingenix, on allegations that they defrauding consumers by manipulating reimbursement rates, according to the American Hospital Association (AHA).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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