UnitedHealth's Ingenix faces mounting legal troubles

A couple of months ago, New York Attorney General Andrew Cuomo rocked the health plan industry when he filed suit against UnitedHealth Group. In the suit, Cuomo argued that UHG was committing consumer fraud in how it sets rates for paying out-of-network physicians, specifically by setting artificially-low rates that leave consumers with big bills. Not only is this a big deal for UHG itself, it's a problem for the health insurance industry as a whole, as several major health insurers also use Ingenix data to set rates.

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.

Meanwhile, the industry is still waiting for Cuomo to drop the other shoe. While New York's AG has promised to sue Ingenix, he hasn't done so yet. Cuomo has said that he is investigating an "industry-wide scheme perpetrated by some of the nation's largest health insurance companies to defraud consumers."

To learn more about the case:
- read this Modern Healthcare article

Related Articles:
NY sues UnitedHealth over MD payments
New York AG expands health plan investigation