UnitedHealth income off 73%

On July 2, the company said it would pay $895 million to settle a class-action lawsuit led by the California Public Employees Retirement System. It also said it was cutting 4,000 jobs nationally, or just under 6 percent of its workforce, and reduced its forecast 2008 profit for the second time.

The legal problems will just keep growing:
CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS’ FRAUDULENT REIMBURSEMENT SCHEME

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 

The battle to save Medicare

Reader Jack Wajda, 69, of Orlando, a retired AT&T executive and financial planner, identifies the single greatest problem with the American health-care system as well as anyone. He writes: “To allow private for-profit insurance companies to decide whether and what type of care we receive is incomprehensible to me.” …

… Now, as Wajda correctly writes, taxpayers pay the private Medicare Advantage plans at least $9,000 a year more per patient than for traditional Medicare, with salespeople getting commissions. On top of that, the prescription benefit, Part D, has also been given to the insurance companies, which are earning high profits.  Read more 

Let’s talk about corporate greed. It is worse than you thought. We know that these companies make money by collecting premiums and then denying care. The question is, money for who? Let’s look at their insider trades:
Cigna’s board of directors and chief corporate officers collectively dumped 129,499 shares of Cigna stock. I tried to add that up to what it would be in dollars, got as far as $17,342,224. That is in addition to their very high salary. How much health care could your municipality buy with $17 million dollars?  Read more 

Insurers don’t like to ’share’

The current mantra of those who support our private insurance model for health care is “shared responsibility.” Their goal is to ratchet up the amount that individuals will have to pay for medical costs, by buying insurance policies that have higher deductibles, larger co-payments, and higher costs for prescription drugs. What “shared responsibility” is about is maintaining insurance company 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 

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.

Doctors and dollars

Typically, reimbursement rates for out-of-network physicians are based on what is generally accepted as the “reasonable and customary” rates charged by doctors in a a common geographic area. But who determines what is reasonable and customary? The attorney general’s staff is focusing on a company known as Ingenix, which collects data that are used by health insurance companies to determine what is charged in a particular region and how much a company will reimburse out-of-network physicians, based on prevailing rates in that area.  Read more