N.Y. AG Prescribes Subpoenas to UnitedHealth Group, Others

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.”  Read more 

Some NY HMOs Impose Consumer Drug Restrictions To Increase Profits  Read more 

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 

Andrew Cuomo Takes On Insurers

For example, Cuomo’s investigation found that in New York City, where a physician might bill $200 for a typical office visit, the amount the insurer would reimburse based on reasonable and customary rates was just $77. So a consumer who expects to pay 20 percent, or $40, for this hypothetical visit would actually get stuck with a bill for $138, because the insurer would only pay 80 percent of the $77 reasonable and customary rate—or $62. “I don’t think most people understand this,” says Ron Pollack, executive director of Families USA, a healthcare consumer advocacy group.  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.