New York Attorney General Andrew Cuomo announced an industrywide investigation into an alleged scheme in which he believes insurers have manipulated reimbursement rates via health information firm Ingenix. Cuomo said in a news release that he plans to file a lawsuit against Ingenix and its parent, UnitedHealth Group as well as three New York insurers that are UnitedHealth subsidiaries.
Rates calculated as usual, customary and reasonable, or UCR, for out-of-network services in the Ingenix database have been dialed down in order to keep reimbursements low, shifting a higher burden to patients, Cuomo said.
UnitedHealth issued a written statement saying the company is cooperating with Cuomos office and disputing his characterization of the numbers. The reference data is rigorously developed, geographically specific, comprehensive and organized using a transparent methodology that is very common in the healthcare industry.
Cuomo said in a news release that Uniteds ownership of Ingenix coupled with the inherent problems with the data it is using clearly demonstrate a broken reimbursement system designed to rip off patients and steer them towards in-network doctors that cost the insurer less money.
At a news conference today, Cuomo was joined by Consumers Union, Families USA and the American Medical Association, whose President-elect Nancy Nielsen said the circumstances suggest that the practice of using skewed UCR amounts is widespread in the health insurance industry.
Cuomo said subpoenaed documents from 16 other insurance companies that show how rates are calculated, member complaints and communications with Ingenix. Gregg Blesch