A new report by the Senate Commerce Committee staff
concludes that flawed databases sold by UnitedHealth Group subsidiary Ingenix, targeted earlier this year by New York Attorney General Andrew Cuomo, are used pervasively by health plans nationwide to determine out-of-network payments.
“Deceptive practices by insurance companies are not only misleading and widespread, they are absolutely unacceptable to me and I won’t give up the fight for consumers until we bring this to a stop forever,” committee Chairman Jay Rockefeller (D-W.Va.) said in a written statement.
Cuomo reached an agreement with UnitedHealth in January
requiring that the company discontinue two databases of physician charges, which the attorney general alleged were tainted by conflicts of interest because they relied on subscribing insurers for their content. Use of the data, he said, left patients unexpectedly on the hook for big bills by causing their plans to underpay out-of-network physicians. Subsequently every health plan in New York reached agreements with the attorney general to stop using the Ingenix products and contribute data and money toward a not-for-profit alternative.
In March, Rockefeller requested information from 18 health plans that don’t do business in New York. The answers revealed that nearly all of them used Ingenix data, though some used it only in certain circumstances or purposes, such as when billed by physicians outside their geographical area. One company said Ingenix data were used only as a benchmark against its own methodology. The inquiry also revealed that New Jersey law actually requires that individual and small-business plans base their out-of-network payments on Ingenix data, according to the report.
UnitedHealth’s agreement with Cuomo requires Ingenix to pull the plug on the databases at issue after a transparent not-for-profit substitute is available, to be administered by a yet unnamed New York university.