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 

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 

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