Yourlawyer.com (UnitedHealth Care Reimbursement Fraud News)

Senator Wants Federal Probe of Ingenix Reimbursements

Tue, 28 Apr 2009 00:00:00 -0700

A key U.S. Senator has called for a federal investigation of the way the UnitedHealth Group subsidiary, Ingenix, used its database to determine reimbursement rates for the Federal Employees Health Benefits (FEHB) program. Recent investigations conducted by the New York Attorney General's office have found that various insurance companies used the Ingenix database to shortchange doctors and patients on reimbursement rates.

In January, the New York Attorney General announced that it had reached a deal with UnitedHealth in which the company would pay $50 million to set up a new database for determining reimbursement. The database is to be owned and operated by a non-profit organization in order to eliminate insurance company conflicts of interest.

Ten other insurers, including Cigna, Aetna and Wellpoint have also have also reached agreements with the New York Attorney General. In addition to ending their use of the Ingenix database, WellPoint and Cigna agreed to pay $10 million each toward the new database. Aetna also recently agreed to end its relationship with Ingenix and contribute $20 million to the new database.

The settlements followed an investigation which revealed that because of Ingenix, many consumers were forced to pay more than they should have for out-of-network care, with underpayment by insurers ranging from ten to twenty-eight percent for various medical services across the state. The Attorney General’s investigation also found that having a health insurer determine the “usual and customary” rate for a service – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward.

In a letter written last month to the Inspector General of the Office of Personnel Management, Sen. Jay Rockefeller (D-W. Va) expressed concerns that the Ingenix database was used to manipulate reimbursement rates for federal workers enrolled in FEHB. According to a report in AMNews, Rockefeller wants to know going back 10 years, how many FEHB plans used Ingenix to set rates and how many federal employees were affected.

Rockefeller sent the letter following two rounds of Senate committee hearings in March over Ingenix and out-of-network pay, AMNews said.

WellPoint Faces Class Action Lawsuit Over Reimbursement Rates

Thu, 26 Mar 2009 00:00:00 -0700

WellPoint Inc. is the latest large insurer to face a lawsuit over the use of the Ingenix database. According to Reuters.com, the American Medical Association (AMA) class action lawsuit accuses WellPoint of using the Ingenix database to underpay doctors for out-of-network care.

The database in question is operated by Ingenix Corp., a wholly-owned subsidiary of UnitedHealth Group. The AMA statement said that the WellPoint class action lawsuit was an expansion of its ongoing effort to expose and prohibit an industry-wide health insurance scheme to defraud patients and physicians of proper reimbursement. The AMA filed a similar class action lawsuits last month against Aetna Health, Inc. and CIGNA Corporation.

The three AMA lawsuits claim that each insurance company conspired with Ingenix on a price fixing scheme that relied on an the Ingenix database to set artificially low reimbursement rates for out-of-network care. A year-long investigation by the New York attorney general confirmed that the Ingenix database is intentionally rigged to allow insurers to shortchange reimbursements, the AMA statement said.

“Physicians will not tolerate an apparent conspiracy that allows health insurers to play by their own rules without regard to patients, or the legitimate costs required to care for them,” said AMA President Nancy H. Nielsen, MD.

In addition to seeking reforms for the invalid payment systems used by Aetna, CIGNA and WellPoint, the class action lawsuits seeks relief for physicians who were seriously harmed by the insurers’ long-term use of the flawed Ingenix database.

Last year, the New York Attorney General’s office began an investigation into allegations the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. The investigation found that because of Ingenix, many consumers were forced to pay more than they should have for out-of-network care, with underpayment by insurers ranging from ten to twenty-eight percent for various medical services across the state. The Attorney General’s investigation also found that having a health insurer determine the “usual and customary” rate for a service – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward.

In January, the New York Attorney General announced that it had reached a deal with UnitedHealth in which the company would pay $50 million to set up a new database for determining reimbursement. The database is to be owned and operated by a non-profit organization in order to eliminate insurance company conflicts of interest.

Cigna, Aetna and Wellpoint have also have also reached agreements with the New York Attorney General. In addition to ending their use of the Ingenix database, WellPoint and Cigna agreed to pay $10 million each toward the new database. Aetna also recently agreed to end its relationship with Ingenix and contribute $20 million to the new database.

AMA Sues Aetna, CIGNA Over Out-of-Network Care

Mon, 23 Feb 2009 00:00:00 -0800

Aetna and CIGNA have been named in a lawsuit filed by the American Medical Association (AMA) over health insurance reimbursement payments. According to the AMA, the lawsuit charges that Aetna and CIGNA used a flawed database to pay physicians artificially low rates for out-of-network care.

The database in question is operated by Ingenix Corp., a wholly-owned subsidiary of UnitedHealth Group. The database used "usual and customary" rates to calculate reimbursements for out-of-network care. The AMA lawsuit seeks damages for physicians from each company commensurate with what doctors would have been paid if the out-of-network pay rates had been calculated accurately. Damages are also being sought for patients who overpaid, the AMA said.

The lawsuit alleges that both Aetna and Cigna intentionally shortchanged reimbursements. It also charges that Aetna, the most active contributor of charge data that Ingenix used in its database, eliminated some higher charges before submitting its information to Ingenix. This skewed the charges lower in the first of several steps to artificially drive down usual, customary and reasonable rates. As a result, the reimbursements calculated were lower than what they should have been, the lawsuit said.

The Ingenix database has already been the subject of an investigation by the New York State Attorney General. UnitedHealth, Aetna, Cigna and several other insurers have agreed to stop using the Ingenix database and contribute millions of dollars to set up a new database that will be run by an independent, nonprofit corporation. But while UnitedHealth has agreed to compensate doctors and patients for its low-ball reimbursements, neither Aetna nor Cigna have agreed to do so.

AMA President Nancy H. Nielsen, MD, PhD, an internist from Buffalo, N.Y., said that in addition to abandoning the Ingenix database, Aetna and Cigna must pay physicians and patients what they should have in the first place.

"We are willing to turn the page, but they need to make whole the physicians and patients who should have been paid fairly."

Cigna, Wellpoint Settle with Cuomo Over Reimbursements

Wed, 18 Feb 2009 00:00:00 -0800

Wellpoint and Cigna, two of the country's largest insurers, have as agreed to stop using the much-maligned Ingenix database for determining reimbursements for customers who seek out-of-network care. Wellpoint and Cigna are just the latest insurers to reach an agreement with New York Attorney General over Ingenix.

The Ingenix database, owned by UnitedHealth Group, is used by many insurers to determine their “usual and customary” rates for out-of-network care. Last year, the New York Attorney General’s office began an investigation into allegations the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits.

The investigation found that because of Ingenix, many consumers were forced to pay more than they should have for out-of-network care, with underpayment by insurers ranging from ten to twenty-eight percent for various medical services across the state. The Attorney General’s investigation also found that having a health insurer determine the “usual and customary” rate for a service – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward.

In January, the New York Attorney General announced that it had reached a deal with Ingenix owner UnitedHealth in which the company would pay $50 million to set up a new database for determining reimbursement. The database is to be owned and operated by a non-profit organization in order to eliminate insurance company conflicts of interest.

In addition to ending their use of the Ingenix database, WellPoint will pay $10 million toward the new database. Cigna has pledged the same amount.

The Cigna and Wellpoint agreements are just the latest announced by Cuomo's office. Aetna also recently agreed to end its relationship with Ingenix and contribute $20 million to the new database. Cuomo reached smaller settlements with the Schenectady-based MVP Health Care, Inc./ Preferred Care, Buffalo-based Independent Health, and Buffalo-based HealthNow. Insurers have so far pledged a total of $90 million to the new database company.

According to a statement from Cuomo's office announcing the Wellpoint settlement, the Attorney General has also as filed notice of intent to sue two other Upstate insurers: Capital District Physician’s Health Plan and Excellus Health Plan (including its Buffalo-based affiliate, Univera), for continuing to defraud consumers and manipulate rates.

UnitedHealth Settles Class Action Lawsuit with Doctor Group

Fri, 16 Jan 2009 00:00:00 -0800

UnitedHealth Group has settled a class action lawsuit over its Ingenix database. The $400 million settlement with the American Medical Association (AMA) comes just days after UnitedHealth settled similar charges with the state of New York for $50 million.

United and the largest health insurers in the country rely on a database operated by Ingenix -a wholly-owned subsidiary of UnitedHealth - to determine their “usual and customary” rate. The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location. Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market.

Last year, the New York Attorney General's office began an investigation into allegations the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. That means many consumers were forced to pay more than they should have. The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General’s investigation also found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward.

Earlier this week, the New York Attorney General announced that it had reached a deal with UnitedHealth in which the company would pay $50 million to set up a new database for determining reimbursement. The database is to be owned and operated by a non-profit organization in order to eliminate insurance company conflicts of interest.

According to Bloomberg.com, the AMA had been in a dispute with UnitedHealth over the same issue since 2000. It's class action lawsuit claimed that UnitedHealth used Ingenix to manipulate payments to doctors and patients for the last 15 years. As part of the settlement, UnitedHealth agreed to put $350 million into a class-action restitution fund to pay physicians and policyholders for services provided by out-of-network providers, the company said in a statement today.

UnitedHealth Group to Pay $50 Million to Settle Claims it Underpaid Reimbursements

Tue, 13 Jan 2009 00:00:00 -0800

UnitedHealth Group used a computer database to overcharge millions of customers, the New York Attorney General said today. According to Andrew Cuomo's office, UnitedHealth Group has agreed to pay $50 million to settle these charges. As part of the settlement with the New York State Attorney General's Office, UnitedHealth Group will also revise the process that health insurers across the country use to determine reimbursements when members receive services from out-of-network providers.

Under the terms of the UnitedHealth settlement, the company will pay $50 million to establish a new, independent database for determining out-of-network reimbursements. It will be run by a qualified nonprofit organization. The nonprofit will own and operate the new database, and will be the sole arbiter and decision-maker with respect to all data contribution protocols and all other methodologies used in connection with the database. The nonprofit will also develop a website where, for the first time, consumers around the country can find out in advance how much they may be reimbursed for common out-of-network medical services in their area.

"Our agreement with United removes the conflicts of interest that have been inherent in the consumer reimbursement system. This has been an industry-wide problem, and it demands an industry-wide reform." New York Attorney General Andrew Cuomo said in the press release. "We commend United for leading the industry on this issue, and we encourage other insurers to follow suit.”

According to the Attorney General's office, the settlement stems from an industry-wide investigation begun last February into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care. The New York investigation concerned allegations that UnitedHealth Group's Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. That means many consumers were forced to pay more than they should have. The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General's investigation also found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward.

According to a press release issued by the office, seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors. In exchange, insurers often promise to cover up to eighty percent of the “usual and customary” rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill. United and the largest health insurers in the country rely on the Ingenix database to determine their “usual and customary” rates, the press release said. The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location. Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market.

In February 2008, Cuomo also announced that he had issued subpoenas to the nation’s largest health insurance companies that use the Ingenix database, including Aetna WellPoint/Empire BlueCross BlueShield. The Attorney General’s industry-wide investigation is ongoing.

United Health Care Out Network Fraud Lawyer Lawsuit United Health Group

Tue, 13 Jan 2009 00:00:00 -0800

UnitedHealth Group (United Health Care) Reimbursement Fraud Lawyers

Keywords: United Health Care Out Network Fraud Lawyer Lawsuit

The lawyers and attorneys at our firm are investigating claims that UnitedHealth Group Inc. (United Health Care) underpaid millions of people in New Jersey, Florida and California when it determined insurance reimbursements for out-of-network care. In January 2009, UnitedHealth Group reached a settlement with the New York Attorney General's office over such charges. The company agreed to pay $50 million to reform the way it determines these reimbursements.

The UnitedHealth Group reimbursement fraud has national implications, and goes far beyond UnitedHealth Group's own customers. The system UnitedHeath Group set up to determine reimbursements was used by insurance companies nationwide. This system was based on a computer database operated by Ingenix, a wholly-owned subsidiary of UnitedHealth. Under this set up, millions of people were underpaid when Ingenix determined reimbursements.

Millions of people in New Jersey, Florida and California likely paid too much for medical care because of UnitedHealth Group's Ingenix reimbursement scheme. Our UnitedHeath Group reimbursement fraud lawyers are committed to making sure victims of this deceptive system are compensated for this fraud.

If you or someone you know were underpaid when your insurance company determined your reimbursement for out-of-network care, it may have been due to UnitedHealth Group's Ingenix system. We urge you to call one of our UnitedHealth Group reimbursement fraud lawyers right away to protect your legal rights.

UnitedHealth Group New York Investigation

Over seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors. In exchange, insurers often promise to cover up to eighty percent of the “usual and customary” rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill. The New York Attorney General's probe revealed how UnitedHealth and other insurers were able to use the determination of "usual and customary" to underpay their customers.

UnitedHealth Group and the largest health insurers in the country rely on the United-owned Ingenix database to determine their “usual and customary” rates. According to New York Attorney General Andrew Cuomo, for over a decade, the Ingenix system has caused American patients to suffer from unfair reimbursements for critical medical services. According to the Attorney General, this is a conflict-ridden system that has been owned, operated, and manipulated by the health insurance industry.

The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location. Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market.

The New York probe concerned allegations that the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. That means many consumers were reimbursed far less than they should have been by UnitedHealth Group and other insurance companies that used the Ingenix database.

According to a press release from the Attorney General's office, the investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General found that having a health insurer determine the “usual and customary” rate creates an incentive for the insurer to manipulate the rate downward.

The Attorney General's investigation also found at least one clear example of the UnitedHealth Group scheme: United insurers knew most simple doctor visits cost $200, but claimed to their members the typical rate was only $77. The insurers then applied the contractual reimbursement rate of 80%, covering only $62 for a $200 bill, and leaving the patient to cover the $138 balance.

The New York investigation into UnitedHealth Care began in February 2008. At that time, Cuomo also announced that he had issued subpoenas to the nation’s largest health insurance companies that use the Ingenix database, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield. The Attorney General’s industry-wide investigation is ongoing.

UnitedHealth Group Settlement

In January 2009, the New York Attorney General's office announced it had reached a settlement with UnitedHealth over the reimbursement charges. Under the settlement the database of billing information operated by Ingenix will close. The entire system large insurers use to determine reimbursements will be reformed.

UnitedHealth will pay $50 million to establish a new, independent database run by a qualified nonprofit organization. This nonprofit will own and operate the new database, and will be the sole arbiter and decision-maker with respect to all data contribution protocols and all other methodologies used in connection with the database.

Cuomo said the nonprofit would develop a website where, for the first time, consumers around the country will find out in advance how much they may be reimbursed for common out-of-network medical services in their area. The nonprofit will also make rate information from the database available to health insurers. Finally, the nonprofit will use the new database to conduct academic research to help improve the health care system, Cuomo said.

Legal Help for Victims of UnitedHealth Group Reimbursement Fraud

The UnitedHealth Group reimbursement fraud lawyers at our firm have a great deal of experience dealing with dishonest insurers. If you believe you are a victim of UnitedHealth Group's Ingenix reimbursement scheme, you may be entitled to compensation. Please fill out our online form or call 1-800 LAW INFO (1-800-529-4636) as soon as possible to discuss your case with one of the experienced UnitedHealth Group reimbursement fraud lawyers at our firm.