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UnitedHealth Care Reimbursement Fraud Victims Lawsuits

UnitedHealth Care Reimbursement Fraud | Lawsuits, Lawyers | Policy Holders, Financial Losses, Damages | Denied Claims, Deceptive System

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.

Ingenix Database Uses Insurers Information

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.