UnitedHealth's Ingenix faces mounting legal troubles

You should validate your information before you publish - or choose your words more carefully. In fact there has been no lawsuit filed against Ingenix and/or United Healthcare. There is an investigation only. Also, ask yourself why the NY Ag office has gone silent on this for the past three months...is it possible he jumped before he looked...and now he's finding out he didn't have correct information, or the right information to back up the allegations? Also of note, the NY Dept of Insurance recently purchased the same data of prevailing health care charges for administration and setting of their own rates. Hmmm...

It's called price fixing and EVERY carrier does it. Whether they call it R&C or UCR, it's a percentile (9 out of 10 doctors recommend Crest) that is then paid at a percentage. What the user does not see in their Benefit Booklet is the Percentile. This percentile was disclosed to the EMPLOYER when purchase of the plan was made. A higher percentile, a higher premium cost. The patient has a problem with the EMPLOYER, not the carrier. The EMPLOYER should have a problem with the carrier that does not explain the lower percentiles.

Then again, New York state's charges MAY have merit. Ingenix and UHG appear to be displaying a pattern.
- In January this year an appellate court in Massachusetts in another lawsuit, threw out ingenix' claim that its health care database is an accurate representation of prevailing provider charges.
- In February this year the Federal Trade Commission issued a complaint charging Ingenix with engaging in unfair and deceptive acts and practices in violation of the Federal Trade Commission Act.
- Now a class action suit is brewing in Connecticut, again with Igenix's database at issue.
And this is just in a period of five months.
Perhaps it is Ingenix/UHG that should be more careful here.

The USR is suppose to be fair and based on the real charges in the same area, by zip, or even by county. I can tell you for ambulance providers they are not even close. I believe they use the lowest UCC they can. I hope they get nailed, and as a consumer I don't mind paying my fair share based on correct information but it sounds like the insurance carriers are passing the buck to the the consumer. My only question is whats taking so long AG Cuomo?

jan 14 2009 - see the comment someone posted back in May....sorry but today UHG settled the lawsuit for 50 million bucks....don't think Cuomo had to "jump" too far

It's high time the authorities finally exposed what the medical profession has known for years. The insurance companies amass inflated premiums, deny patients proper healthcare benefits and cheat the providers out of reasonable reimbursement.

Ingenix, United and the other highway robbers just make up their data with the lowest numbers they can get away with! There's no way "usual and customary" is less than provider costs! For example, United pays $35 for a hearing test that takes half an hour and is done by a $60/hr masters or doctoral degreed audiologist on a $6,000 audiometer in a $15,000 sound treated booth
in a healthcare office with rent, phones, electrical, mandatory record keeping and insurances. Senior citizens and children often
take over an hour.

Question: How do United and other scamming insurers afford hundreds of millions in settlements and the tallest buildings in most
cities?

Answer: There's only one way: high revenue in from high premiums and low revenue out from artificially low payment of claims.

Ingenix will have to face a lot's of challenges in the market due to consumer fraud. If Ingenix is found as guilty then it will be a matter of disgrace for it. UHG should take care of these types of frauds to maintain it's position. I think UHG is ready to face these challenges and i hope General Andrew Cuomo will take a strict action on Ingenix.

Stuart

I'm a doctor and pray for the good of healthcare that the conspirator health plans who have jumped on the low ball UHG/Ingenix bandwagon go down like dominos. They've
arbitrarily lowered "usual & customary" to now below costs.
They're far below Medicare which has always been discount
care at about 50% discounts.

Small wonder the health plan stocks soak and they occupy the largest skyscrapers in any city. Just ask yourself how they amass such profits. The answer is there's only one way: taking in premiums and not paying them out on claims at the true level,
leaving fat profits.

I hope the perpetrators end up behind bars. Behind the financial fraud are broken lives and families and medical practices that go under. In California skilled surgeons turn to doing cosmetic surgery when insurance doesn't pay the bills. Most doctors hate seeking payment from patients especially the working middle class who don't qualify for governmental aid.

Cigna, Aetna, Blue Cross, Blue Shield, Health Net, Unitedhealthcare have all fed from the same trough for years. It's called price fixing and it's illegal as H - e- hockey sticks. I'm a nurse and have a family to support so see their conniving graft from both ends. In our area the good doctors threw in the towel and cancelled all their network provider contracts in order to have "concierge" and "charity" practices.

That way, the wealthy don't mind paying for special attention from top quality doctors can then afford to reduce or waive charges for those in need.

It leaves the grubby mits of the robbers and thieves out of the till. My own daughter has leukemia and I'm sick of fighting with the insurance idiots. They can't even pronounce the name of the drugs they deny coverage for!!!!!!

I hope someone will also go after CCC Information Services which lowballs car values for insurance settlements. It's another consumer fraud. Only a few reputable insurers don't use them.

Without revealing too much of where I work, we had one doctor charge $220,000 for surgery done on one day......on one day!!!!! R&C lowered this amount to just over $28,000 for one doctor for one day and he was incensed that we did not allow the full $220,000. Problems come from places other than the insurance companies.