NEW YORK (Reuters)—New York Attorney General Andrew Cuomo said
Wednesday he is conducting an industrywide probe of health insurers
into an alleged scheme to defraud consumers by manipulating
reimbursement rates.
At the center of the scheme is Ingenix, the nation’s largest provider
of health care billing information, which serves as a conduit for rate
data to the largest insurers in the country, Mr. Cuomo said in a
statement.
Mr. Cuomo said he intends to sue Ingenix, Ingenix parent UnitedHealth Group Inc., and three additional subsidiaries.
Mr. Cuomo said he has issued 16 subpoenas to the nation's largest
health insurance companies, including Aetna Inc., CIGNA Corp. and
Empire Blue Cross Blue Shield, a unit of WellPoint Inc.
The subpoenas to insurers request documents on how they compute
reasonable and customary rates and communications between Ingenix and
the insurers on the issue, among other information, Mr. Cuomo said.
A six-month probe found that Ingenix operates a “defective and
manipulative” database that most major health insurance companies use
to set reimbursement rates for out-of-network medical expenses, Mr.
Cuomo said.
"Getting insurance companies to keep their promises and cover medical
costs can be hard enough as it is," Mr. Cuomo said. "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."
UnitedHealth said it was in ongoing discussions with Mr. Cuomo’s office on the issue and would continue to cooperate fully.
"UnitedHealth Group recognizes the excellent health care delivered to
patients by the physicians of New York and is committed to fair and
appropriate payment for physicians, the state's other health care
providers and consumers," UnitedHealth said in a statement.
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