Reimbursement Database Investigated by NY Attorney General
February 23rd, 2008
In a case that could have national ramifications, New York Attorney General Andrew M. Cuomo announced this week that he is conducting an investigation into health insurers regarding the use of data to manipulate reimbursement rates to providers.
Ingenix, a subsidiary of United HealthCare, and 16 health insurers have been subpoenaed. At the center of the investigation is the Ingenix database, used by insurers, employers and others to establish benchmarks, and for use in reimbursement and contract negotiations. Usual, reasonable and customary rates are also established for non-participating providers using this database.
“The investigation launched by New York Attorney General Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members, ” AMA President Elect, Nancy H. Nielsen, MD, PhD, said in a statement released on February 13th. “UnitedHealth Group and other health insurers have shortchanged tens of millions of patients who agreed to pay higher premiums for access to their choice of physicians from outside a health insurer network.”
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