NY AG Charges the Companies Used 'Rigged Data to Manipulate' Reimbursement Rates to Customers

N.Y. AG Prescribes Subpoenas to UnitedHealth Group, Others | Charges the Companies Used 'Rigged Data to Manipulate' Reimbursement Rates to Customers

The nation's largest health care insurer, four of its subsidiaries and a number of other large insurers are being served subpoenas -- 16 in all -- in a suit to be brought by New York Attorney General Andrew Cuomo that charges the companies used "rigged data to manipulate the reimbursement rate to their customers who filed claims."

At the center of the scheme, according to the attorney general, is Ingenix, Inc., "the nation's largest provider of health care billing information, which serves as a conduit for rigged data to the largest insurers in the country."

Cuomo notified Ingenix and its parent company, UnitedHealth Group, of his intent to file suit and subpoenaed 16 other companies, including Aetna, CIGNA, and Empire BlueCross BlueShield. The central allegation is that companies manipulated reimbursement rates. In addition to Ingenix, the suit is also encompassing three other UnitedHealth Group subsidiaries. ...
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"Further, the investigation found that two subsidiaries of United (the "United insurers") dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix," Cuomo's office said.

"The Attorney General's investigation found that by distorting the 'reasonable and customary' rate, the United insurers were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs."

"When insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need," ...