Early this year, a pair of New York hospitals filed a $50 million Racketeer Influenced and Corrupt Organizations (RICO) suit against UnitedHealth. The two had been battling with UnitedHealth for years, in part over claims that UnitedHealth subsidiary Oxford Health scared away patients by telling them that the hospitals weren't in their networks. Now one of them, Jamaica Hospital Medical Center, has made a new offensive, sharing what it says is strong evidence that Oxford has engaged in ongoing age discrimination. In going public with its numbers, Jamaica Hospital has taken a very unusual step, one which is certain to ratchet up the stakes in its battle with Oxford. (Of course, that's exactly the point.)
According to numbers cited in the Jamaica Hospital statement, Oxford has been systematically denying insurance coverage for patients requiring specialized acute rehabilitation and traumatic brain injury. The data, compiled during the 19-month period between January 1, 2006 and August 2, 2007, indicates that 46 of 58 Oxford-insured patients who were referred for acute rehab or traumatic brain injury rehab were denied coverage. The average age of patients denied acute rehab or TBI by Oxford was 74.8, while the average age of those authorized was 49.9, the hospital says. Jamaica Hospital also contends that Oxford has frequently denied coverage for treatment that would be automatically covered by fee-for-service Medicare under its Medicare Advantage program.
To find out more about the battle:
- read this Jamaica Hospital statement
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