UnitedHealth Settles in Court after Accusations of Overcharging
After being accused of overcharging millions for health care insurance, one of America’s biggest insurers has agreed to a $50 million settlement pay-out.
Hundreds of people made complaints about charges made by Oxford Insurance, and its parent company UnitedHealth Group. The parent company claims that its reimbursement rates are based on “independent research from across the health care industry,” but an investigation by the New York Attorney General’s office revealed that it’s actually Ingenix, a research firm owned and operated by UnitedHealth Group, that supplies the data.
This isn’t just a case of conflict of interest, however – it gets much worse.
According to New York Attorney General Andrew Cuomo, Ingenix has been manipulating the data, allowing UnitedHealth Group’s Oxford Insurance to pay less for reimbursement of its customers.
Surprising Findings in the Health report
Cuomo’s report says that UnitedHealth Group has been under-reimbursing on an enormous scale, “to the tune of at least hundreds of millions of dollars:” in a “huge scam that affected hundreds of millions of Americans.”
In one example, Yonkers, New York, resident Mary Jerome ended up owing a whopping $46,000 for procedures that Oxford Insurance determined were not “usual, customary, or reasonable.”
So what were these unnecessary procedures – cosmetic surgery? No. Those procedures that the company decided did not require reimbursement were chemotherapy and other medications Mary Jerome needed to fight the ovarian cancer she was diagnosed with in 2006.
So far, only UnitedHealth Group and Oxford Insurance have been investigated. However, several other major insurance companies use data supplied by Ingenix. Among them are Aetna, CIGNA, and WellPoint/Empire BlueCross BlueShield.
UnitedHealth Group Response
UnitedHealth Group continues to deny the charges, saying instead that it agreed to the settlement only to solve the conflict, “We respectfully disagree with the New York Attorney General’s findings that we manipulated data … (or that our ownership of Ingenix was a conflict of interest.) We agreed to his settlement because it was an effective way to address any perceived conflict of interest.”
Ivestigations Continue
Cuomo’s investigations aren’t over. In light of the fact that several other large insurers use Ingenix data to determine patient reimbursement rates, the questions continue to pile up.
UnitedHealth Group’s $50 million settlement will be used in the creation of a non-profit, organization that will help determine reimbursement levels in a genuinely independent fashion.
photo credit: rick
Tags: health bills, health care, overcharging, oxford health, settlement, unitedhealth
