In a settlement with New York Attorney General Andrew Cuomo, UnitedHealth Group has agreed to pay $50 million toward the creation of an independent database of physician charges that would replace databases that are administered by its subsidiary Ingenix and long used by insurers to calculate what they pay for out-of-network care. UnitedHealth did not admit any wrongdoing.
Insurers often pay a percentage of what they calculate as usual, customary and reasonable fees for services in a geographic area, commonly relying on Ingenix data, when beneficiaries seek care outside their provider network. Cuomo alleged that the companies manipulated those numbers to justify lowball payments. Once you change Ingenix, you will change the entire system, Cuomo said during a news conference announcing the settlement. The new database will be run by a not-for-profit, Cuomo said, and would be transparent, giving consumers, providers and insurers access to the information. Once its readyperhaps in a matter of months, Cuomo saidthe two Ingenix products at issue will be shut down.
We regret that conflicts of interest were inherent in these Ingenix database products, UnitedHealth General Counsel Mitchell Zamoff said. This solution will give people more information they can use to make decisions for themselves and their families.
In February 2008, Cuomo announced he had launched an industrywide investigation into the setting of out-of-network payments and delivered subpoenas to 16 insurance companies. No lawsuit or criminal charges were filed in the probe, but Cuomo said his office would be working with other companies after today, one by one, until we reform the entire system.
American Medical Association President Nancy Nielsen appeared with Cuomo and noted the physicians group has been working on the same issue for several years. Now the data will be reliable, and people will know what theyre getting. That wedge that was driven between patient and doctor will go away.