January 13, 2009 UnitedHealth Group Inc. settled with the New York State Attorney General Andrew Cuomo after a probe of the independence of its database used to set reimbursement rates for patients’ medical bills. The probe found that Ingenix operates a ‘defective and manipulative’ database used by major health insurers to set reimbursement rates for out-of-network medical expenses. The Ingenix skewed rates downard compared to the market rates which would shortchange the consumers. In Cuomo’s yearlong investigation, he found that consumers across the country had paid more than they should have for out-of-network services through skewed patient reimbursement rates. He believes that the overcharges to consumers could range in the hundered of millions of dollars.
The settlement forces UnitedHealth to shut down its Ingenix medical billing service and pay $50 million toward starting a new independent database to determine market rates for healthcare procedures. The agreement contains no admission of wrongdoing. Cuomo is waiting on the outcome of current lawsuits filed by other parties before his office takes its own actions to pursue restitution.
