New York Attorney General Andrew Cuomo announced an "industrywide" investigation into an alleged scheme in which insurers and health information firm Ingenix manipulated reimbursement rates. Cuomo said he has issued 16 subpoenas to insurers and plans to file a lawsuit against Ingenix, its parent, UnitedHealth Group, and three UnitedHealth subsidiaries.
This investigation has just been announced by Attorney General Cuomo. Let's hope that this is only the first act, and that other state AG's will follow his courageous lead.
Here is a link to the press release just issued by Cuomo's office.
And as you're reading this, please keep in mind that these are the same criminal companies that sadly our two Democratic candidates for President want the American people to entrust their lives to.
And a brief message to Henry Waxman. When you're finished with Roger Clemens, do you think you could do the business of the American people and get the insurance industry CEOs under oath?
When you read this, you're going to get very angry.
I'd like to remind you that several months ago, I told you about the criminals fraudsters at Igenix and the Lewin Group.
This is a portion of the AG press release, I urge you to read it in its entirety.
CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS’ FRAUDULENT REIMBURSEMENT SCHEME
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Database Company Ingenix – Used by Dozens of Insurers – at Center of Scheme
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Cuomo Notifies Ingenix and its Parent, UnitedHealth Group, of Intent to File Suit; Subpoenas 16 Other Companies
NEW YORK, NY (February 13, 2008) – Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation’s largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country.
Cuomo also announced that he has issued 16 subpoenas to the nation’s largest health insurance companies including Aetna (NYSE: AET), CIGNA (NYSE: CI), and Empire BlueCross BlueShield (NYSE: WLP), and that he intends to file suit against Ingenix, Inc, its parent UnitedHealth Group (NYSE: UNH), and three additional subsidiaries.
The six-month investigation found that Ingenix operates a defective and manipulated database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses. Further, the investigation found that two subsidiaries of United (the "United insurers") dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix.
Under the United insurers’ health plans, members pay a higher premium for the right to use out-of-network doctors. In exchange, the insurers promise to cover up to 80% of either the doctor’s full bill or of the "reasonable and customary" rate depending upon which is cheaper.
The Attorney General’s investigation found that by distorting the "reasonable and customary" rate, the United insurers 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," said Attorney General Andrew Cuomo. "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."
Cuomo’s investigation also found a clear example of the 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 United insurers and many other health insurance companies relied on the Ingenix database to determine their "reasonable and customary" rates. The Ingenix database used the insurers’ billing information to calculate a "reasonable and customary" rate for individual claims by assessing how much a similar type of medical service would typically cost, generally taking into account the type of service, physician, and geographical location. However, the investigation showed that the "reasonable and customary" rates produced by Ingenix were remarkably lower than the actual cost of typical medical expenses.
http://www.oag.state.ny.us/...
If you want to thank him, here is a a link to the emailcontact page on the AG web site.
Please, under no circumstances, bombard him with calls.
Thank You, Andrew Cuomo.