In a settlement announced last month, one of the nation’s largest health insurers has agreed to pay $50 million for overcharging millions of Americans for health care. The New York Attorney General’s office launched an investigation after receiving hundreds of complaints about Oxford Insurance and its parent company, UnitedHealth Group, which claims to rely on “independent research from across the health care industry” to determine reimbursement rates. In actuality though, it relies on Ingenix, a research firm which is owned by UnitedHealth Group. New York Attorney General Andrew Cuomo says Ingenix has been manipulating the numbers so insurance companies pay less. In a just-released report, it’s contended that Americans have been “under-reimbursed to the tune of at least hundreds of millions of dollars.”
Although UnitedHealth Group and Oxford Insurance were the only entities investigated, other major insurers use Ingenix, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield. Attorney General Cuomo had this to say:
This is a huge scam that affected hundreds of millions of Americans (who were) ripped off by their health insurance companies. This was unethical, and it robbed vulnerable patients of insurance reimbursements they deserved.
This is what Nancy Nielsen, president of the American Medical Association, had to say about the nationwide problem:
This is huge. This problem went across the country. It’s industry-wide, throughout insurers. So, it touched every state. Many doctors. Many millions of patients, and this has been going on for years.
I understand there are more insurers under investigation. Attorney General Cuomo is currently investigating other insurance companies that use Ingenix’s database to determine reimbursement rates for patients and taking steps to make sure this won’t happen again in the future. The $50 million settlement UnitedHealth Group will pay will be used to create a nonprofit organization that will determine reimbursement rates for patients.
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