UnitedHealth’s Ingenix faces mounting legal troubles

Now, a consumer is raising the stakes a bit by attempting to get class action status for a suit against Ingenix itself. In the suit, which was filed in Connecticut, plaintiff Jeffrey Weintraub contends that he was defrauded by a conspiracy in which health plans calculate lowball, out-of-network rates using bogus Ingenix data. Weintraub also names UHG, Oxford health Plans, Aetna, Cigna and other insurers in the suit.  Read more 

Rochester Turning says this kind of corporations-over-people is unbelievable coming from a Democrat. The Albany Project wants to know what Schumer meant by that remark.

Major insurance companies drop on sector woes

Although UnitedHealth Group reported a positive fourth quarter—including a 62% increase for its Ingenix database system business—the company’s stocks have since plummeted, partially because of an ongoing investigation by New York Attorney General Andrew Cuomo. On March 12, shares fell to a 52-week low, bottoming out near $36 after seeing prices as high as $60 in December 2007. …  Read more 

Software Helps Insurers Profit from Denials

New York’s attorney general investigates possible fraud in an industry built on denying care, and two U.S. representatives want Medicare to have no part in it.

For the past couple years, Martin Jensen has been sounding an alarm, shouting to doctors and hospitals about the biggest danger they probably don’t know about. As an independent information technology consultant to hospitals, Jensen warns that health insurers are increasingly devising more sophisticated means of denying services either upfront or sniffing out money they believe to have “mistakenly doled out.”

Cuomo expands probe of health insurers

ALBANY, N.Y. (AP) - New York Attorney General Andrew Cuomo said Thursday he issued new subpoenas to Aetna Inc., Cigna Corp., UnitedHealth Group Inc. and WellPoint Inc., and other health insurers in a broadening investigation of possible fraud costing consumers hundreds of millions of dollars.

Cuomo is also looking for documents and to subpoena testimony from the CEOs of Empire Blue Cross Blue Shield, Excellus, and HIP health insurers.  Read more 

Andrew Cuomo Takes On Insurers

For example, Cuomo’s investigation found that in New York City, where a physician might bill $200 for a typical office visit, the amount the insurer would reimburse based on reasonable and customary rates was just $77. So a consumer who expects to pay 20 percent, or $40, for this hypothetical visit would actually get stuck with a bill for $138, because the insurer would only pay 80 percent of the $77 reasonable and customary rate—or $62. “I don’t think most people understand this,” says Ron Pollack, executive director of Families USA, a healthcare consumer advocacy group.  Read more 

Let’s hope this is a sign of things to come:

ALBANY — In a major victory for Gov. Eliot Spitzer and his party, a Democratic assemblyman won a stunning upset in a State Senate election on Tuesday in a district that has been in Republican hands for a century.

The win reduces the Republicans’ majority to one seat and will intensify pressure on the majority leader, Joseph L. Bruno, as he tries to maintain his party’s grip on the Senate, which it has controlled for more than 40 years.

The Democrat, Darrel J. Aubertine, a dairy farmer, leaned heavily on Mr. Spitzer’s media consultant and the state Democrats’ money as he waged a costly campaign against the Republican, William A. Barclay, a lawyer and an assemblyman whose father once held the Senate seat.

Mr. Aubertine won 52 percent of the vote to 48 percent for Mr. Barclay, according to unofficial results. Republicans outnumber Democrats 78,454 to 46,824 in the north country district, and Mr. Barclay had been favored to win.

“I think it has to send shivers up their spines,” said the state Democratic chairwoman, June O’Neill, about the Republicans, as whoops and hollers erupted around her at a victory party for Mr. Aubertine at an Italian-American civic club in Watertown.

She added: “The Democratic Party can meet and beat the Republican machine anywhere. If we can do it here, we can do it anywhere.”

Link  Read more 

UnitedHealth Poised for 13% Growth Unimpeded by Cuomo

Feb. 21 (Bloomberg) — UnitedHealth Group Inc., the largest U.S. health insurer, is poised to reach its forecasts of 13 percent profit growth this year and next, even after being accused of cheating customers by New York’s attorney general.

Don’t even know where to begin.

Doctors and dollars

Typically, reimbursement rates for out-of-network physicians are based on what is generally accepted as the “reasonable and customary” rates charged by doctors in a a common geographic area. But who determines what is reasonable and customary? The attorney general’s staff is focusing on a company known as Ingenix, which collects data that are used by health insurance companies to determine what is charged in a particular region and how much a company will reimburse out-of-network physicians, based on prevailing rates in that area.  Read more 

And fuck you four judges too afraid to admit that the Constitution guarantees equal protections for everyone, no matter how much the idea of me and my girlfriend being happy together shrivels your pathetic manhood.You won’t see me advocating for Spitzer any time soon:

ALBANY, N.Y. (AP) — New York’s highest court ruled Thursday that gay marriage is not allowed under state law.

The Court of Appeals in a 4-2 decision rejected arguments from gay and lesbian plaintiffs throughout the state that their inability to get marriage licenses in New York violated their constitutional rights.

Judge Robert Smith said New York’s marriage law is constitutional and clearly limits marriage to between a man and a woman. Any change in the law should come from the state Legislature, he said.

“We do not predict what people will think generations from now, but we believe the present generation should have a chance to decide the issue through its elected representatives,” Smith wrote.

Gov. George Pataki’s health department and state Attorney General Eliot Spitzer’s office have argued New York law prohibits issuing licenses to same-sex couples. The state had prevailed in lower appeals courts.  Read more