Though the state of New York investigated 16 health plans when it went after alleged use of bad data to underpay doctors, it looks like Aetna drew the short straw. Aetna agreed this week to pay $20 million to settle charges that it shortchanged doctors by basing out-of-network physician payments on data from UnitedHealth Group's Ingenix subsidiary.
UnitedHealth itself has already agreed to pay about $350 million to settle charges that the Ingenix database contained artificially-low physician charge data, including a $300 million payment to the AMA to settle a class-action suit over use of the data. Both the AMA and the state of New York contended that the lowball prices in the Ingenix database were causing health plans to pay unfairly low out-of-network rates.
In its settlement with the state of New York, UnitedHealth also agreed to kick in $50 million to help pay for the establishment of a new physician charge database, maintained by an independent non-profit, which would replace the one Ingenix uses today. Aetna's $20 million will also go toward establishing the new database.
Get more background on the Aetna settlement:
- read this piece from The Hartford Courant
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