UnitedHealthcare

GA doctors sue state for access to contract terms

Anne Zieger — Tue, 05 Aug 2008 12:29:02 -0400

For the last few years, a group of physicians has been working to force the health insurer administering Georgia's state employee health benefits plan to disclose what it pays physicians around the state, as well as language found in its physician and hospital contacts. While the doctors assert that such details should be public--given state open records laws--United continues to insist that such details are proprietary. Now, it appears that the state Supreme Court will get to decide whether the group will get its wish.

In 2005, United Healthcare got a five-year, $55 million contract to service the state's self-funded plan. The medical group, the South Georgia Physicians Assn. LLC, later became aware that United Healthcare was paying different fee schedules to physicians in different parts of the state. South Georgia Physicians, an IPA, has about 280 physician members that practice in about 30 counties that are largely rural.

Southern Georgia Physicians, in cooperation with the Medical Association of Georgia, filed an open records request in early 2006 asking for documents related to the state contract in an effort to see whether it was being paid fairly. The request relied on state law requiring that private entities working on a government agency's behalf be subject to public disclosure. However, United contended that the contracts and schedules South Georgia wanted were trade secrets.

The two battled back and forth until they reached the Georgia Court of Appeals, which said that doctors should get at least the records United had already turned over to the state. Now, both have filed an appeal with the state Supreme Court.

To learn more about the case:
- read this AMNews article

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UnitedHealthcare to pay $250K fine in Ohio

Anne Zieger — Tue, 29 Jul 2008 10:53:30 -0400

Health plan UnitedHealthcare has agreed to pay a $250,000 fine to settle with the state's Department of Insurance over letters it sent to policyholders concerning a health system in its network. The health plan sent out letters in May informing some members that they would have to change providers, given that a central Ohio health system, OhioHealth, appeared to be on the verge of giving up its contract. The letters said that beneficiaries would need to find new providers as of June 10--making no mention of the fact that UnitedHealthcare was still in contract talks with the health system.

Ultimately, OhioHealth and UnitedHealthcare managed to seal a deal seven hours before their contract was set to expire. That meant that despite the letters, UnitedHealthcare's beneficiaries could continue to see their OhioHealth providers. Because of the letter, however, patients made scores of calls to physician practices and OhioHealth's three hospitals, seeking reassurance that they could still see their existing providers.

The Department of Insurance, which dubbed the letters "confusing" and "misleading," is requiring UnitedHealthcare to submit a plan describing how it will improve its communications with members. The fines it imposed include a $150,000 civil penalty and $100,000 in administrative costs.

To find out more about the investigation:
- read this Marion Star piece

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UnitedHealthcare subsidiaries to pay $800K in fines

Anne Zieger — Fri, 25 Jul 2008 11:35:42 -0400

UnitedHealthcare subsidiaries have agreed to pay almost $800,000 in fines to settle allegations by the North Carolina Department of Insurance that they'd violated state law regarding claims payment and other issues. This is the second time UnitedHealthcare has settled with the state in the past five years, having paid $2.2 million in 2004 to settle with regulators over problems with claims processing.

The 2004 settlement led to a broader investigation and agreement with regulators in 39 states and the District of Columbia, all of whom settled with UnitedHealthcare earlier this year. In the larger settlement, UnitedHealthcare resolved concerns noted by state regulators in several areas, including claims processing, settlement and payment; coordination of benefits; appeals, grievances and complain resolution; explanation of benefits and provider networks.

To learn more about the settlement:
- read this N.C. Department of Insurance press release

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AMA issues first health insurer report card

Anne Zieger — Tue, 17 Jun 2008 12:28:49 -0400

Increasingly, providers and their vendors have begun to rate insurance companies. This comes in part as a means of turning the tables on the insurers who, some say, have become far too focused on rating and ranking providers. The latest to enter the "rate your insurer" sweepstakes is now the American Medical Association, which issued its first health insurance report card yesterday at the group's annual meeting. The report card, which purports to be an attempt to cut the cost of claims processing for doctors, compares payment rates for Medicare and seven national commercial health plans on how quickly and accurately they pay claims. The report card is based on a random sample taken from 3 million claims.

According to the report card, UnitedHealthcare has the lowest rate of contract compliance, with about 62 percent of medical services billed paid by UHC at the contracted rate, compared with 98 percent for Medicare and 71 percent for Aetna. Medicare actually performed better than private insurers in most areas, in part because it isn't obliged to constantly prove to employer customers that it's being tough on costs, observers noted.

To learn more about the report card:
- read this Associated Press piece

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Insurers not happy with concierge medicine

Mon, 17 Mar 2008 07:59:56 -0400

A number of insurers aren't too pleased with the small but growing trend of "concierge medicine." For an annual retainer fee, patients can have more personalized care, which may include house calls and more access to their physician. By charging the up-front fee, doctors can afford to cut their caseload and spend more time with fewer patients.

But United Healthcare and Cigna both say the concierge model violates their contracts, and United Healthcare is dropping four Texas physicians because of the practice. Insurers say that doctors may charge patients for co-payments or co-insurance, but not additional fees. Some practices have cut insurance out entirely, while others still have patients relying on insurance to cover most of their visit, which the insurers don't like that at all. However, Aetna, Humana and Blue Cross Blue Shield of Texas say they will accept the concierge model as long as patients don't expect reimbursment for their doctor's retainer fee.

For more on the concierge/insurer conflict:
- read this article from the Houston Chronicle

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Study: Health views vary along ethnic lines

Tue, 11 Mar 2008 07:59:58 -0400

A new study suggests that how you rate your healthcare provider may depend somewhat on your ethnic background. The study, which will be published in the journal Health Affairs, found that minorities are more likely than white patients to rate their healthcare as fair or poor, particularly Chinese-Americans, blacks born in Africa and Vietnamese-Americans. This is a particular concern given that improving patients' perception of their care is important to improving outcomes; patients who don't feel their care is satisfactory spend less time with physicians and may suffer as a result. Unfortunately, many minorities feel that their time spent with doctors isn't that productive. While three-quarters of whites reported that their doctor listened to them carefully, that percentage fell sharply, to 62 percent, for Korean-Americans, and 58 percent for Central and South Americans. These statistics were drawn from a survey of 4,334 adults by researchers with Harvard University and the Robert Wood Johnson Foundation.

To get more data from the study:
- read this Associated Press piece

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New York AG expands health plan investigation

Fri, 07 Mar 2008 06:59:58 -0500

A few weeks ago, New York Attorney General Andrew Cuomo made national news when he filed suit against UnitedHealth Group, arguing that the plan is committing consumer fraud in how it sets rates for paying out-of-network physicians. Specifically, he argued that UnitedHealth Group's Ingenix subsidiary, whose services are used by many other insurers, set artificially low rates that unfairly saddled consumers with excess charges. At the time, he promised that he'd also be investigating several other health insurers operating in the state on similar charges.

Now, Cuomo is following through, issuing subpoenas to a long list of additional health plans, including Aetna, Cigna, WellPoint, Empire Blue Cross Blue Shield, Excellus and the combined Group Health/HIP Health Plan. (To date, no subpoena for Ingenix has been issued, though Cuomo is in talks with the firm.) Not only does Cuomo want the plans' CEOs to testify as to whether they knew Ingenix's fee structure was artificially low, he's also asking for all e-mail correspondence involving the CEOs, as well as their COOs, CFOs, presidents and employees who supervise claims.

To learn more about Cuomo's case:
- read this Associated Press piece

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NY plans to sue UnitedHealth over MD payments

Thu, 14 Feb 2008 06:59:58 -0500

New York Attorney General Andrew Cuomo has announced plans to file suit against UnitedHealthGroup, arguing that it's perpetrating consumer fraud in how it sets rates for paying out-of-network physicians. He says that by setting the "reasonable and customary" rates used to pay non-network doctors at an artificially low level, UHG is unfairly saddling consumers with large balances. As most readers know, consumers typically pay 20 percent of a physician's charges when they use an out-of-network benefit. However, if UHG claims that a physician visit in New York City costs $77, and pays 80 percent ($62), that leaves a consumer with a $138 balance if the real charge is $200.

Cuomo, who also plans an investigation of 16 other health insurers operating in the state, contends that many of these insurers have also been systematically underpaying doctors when consumers use out-of-network benefits. However, UnitedHealthGroup is a particular target, because it owns Ingenix, the company used by many of the health plans to calculate the "reasonable and customary" rates.

To learn more about Cuomo's plans, and UHG's arguments:
- read this New York Times piece

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UnitedHealth's McGuire gives up $400M in assets

Fri, 07 Dec 2007 06:59:58 -0500

While the man is still rolling in bucks, this has gotta hurt. UnitedHealth Group former CEO has agreed to surrender more than $400 million under new agreements reached with his former employer and the Securities and Exchange Commission. McGuire, who had already given up an additional $200 million, has been ordered to give back 9.2 million companies shares (worth about $320 million), $91 million in retirement income and $8 million in a savings account. He had previously agreed to give up with prior stock option awards which were repriced between 1994 and 2002.

The agreement settles charges brought by the SEC against McGuire under the Sarbanes-Oxley Act, legislation enacted in the wake of the Enron scandal which prohibits various types of questionable financial conduct by officers of public companies. That includes a prohibition on profiting from stock sales made while execs mislead investors. An internal UnitedHealth investigation had found that he had backdated shares for himself and other execs.

To find out more about the settlement:
- read this Modern Healthcare article (reg. req.)

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NY accuses ASCs of collecting overpayments

Fri, 07 Dec 2007 06:59:55 -0500

According to a new state audit, four large New York ASCs have been playing some inappropriate financial games. The ASCs are accused of waiving out-of-pocket fees for members of the state-employee health plan, then collecting an estimated $8 million in extra costs by inflating charges to the state's insurance administrator, United Healthcare. The accusation came from a report released by the office of the New York State Comptroller, Thomas DiNapoli. Auditors there, who examined claims from January 2001 through December 2006, are asking UnitedHealthcare to recover the $8 million.

Centers named by DiNapoli as having received overpayments include the Endoscopy Center of Long Island, Garden City, Capital Region Ambulatory Surgery Center, Albany, Digestive Health Center of Huntington and Day-Op Center of Long Island, Mineola.

To find out more about the audits:
- read this Modern Healthcare piece (reg. req.)

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