New York Attorney General Reaches Agreement with United HealthCare to Shut Down Ingenix - Aetna also agrees to Discontinue Use of Ingenix

On Tuesday, United HealthCare agreed to the terms of a settlement proposed by the New York Attorney General to end the investigation into the practices if its subsidiary, Ingenix, Inc.  (Link to earlier post about the investigation.)  The settlement, requires United HealthCare to

-          Pay $50 million to found a new database that will be run by a not-for-profit organization located at a “university level school of public health or other appropriate school in New York”; and

-          Notify any states that require use of Ingenix for out-of-network services; and

-          As soon as the new database is operational, close Ingenix; and

-          During the “transitional period”  add disclosures to UHC’s site disclosing any use of Ingenix, disclosing Ingenix is UHC – owned and promoting the new database and;

-          Begin using the new database for its own insureds.

The agreement between the NY AG’s office and the UHC, called the “Assurance of Discontinuance Under Executive Law § 63(15)” finds a conflict of interest in UHC’s ownership of Ingenix, and a similar conflict of interest on the part of other insurers that submitted rate information to Ingenix, and labeled the database a “black box” for consumers requiring insurers “to write effectively a blank check for out of network physician services.”  It finds that the existing arrangement is a “national problem affecting millions of consumers” and requires “fundamental reform by creating a new, independent database, not controlled by any insurer…”  It further finds that the replacement database should “determine fair and accurate reimbursement rates”, in a transparent manner and make them available to the public.  The Agreement highlights the value of allowing consumers to “be able to find out the rate of reimbursement before they decide to go out of network, and … to find out the purchase price before they shop for insurance policies or for out-of-network care.”

The replacement database will be unaffiliated with any insurer and will determine the protocols for collecting data on provider rates and “other methodologies used in connection with the database”.  The Attorney General promises that the replacement database will maintain a website that consumers can use to determine in advance how much they will have to pay to use an out-of-network provider.  It will allow consumers to search by medical service or zip code and will show where the provider’s / practitioner’s prevailing charge falls within the range of charges for providers of similar services in the region.  The rate information will also be available to other insurers and for academic research.  The NY AG will approve the Board of Directors for this organization.

The UHC settlement also appears to bring an end to actions brought by the Medical Society of New York, Consumers Union and the AMA.

Attorney General Cuomo said that the investigation into other insurers’ use of the Ingenix database is ongoing.

Link to Attorney General press Release: Press Release

Link to UHC Assurance of Discontinuance Under Executive Law § 63(15)

Link to Aetna Assurance of Discontinuance Under Executive Law § 63(15)

Comments

[Busby SEO Test]

thanks for the nice information about the Health Care to Shut Down Ingenix

[Chuck salvo]

I am not quite sure what you mean by "Shut Down Ingenix"? I was not aware the entire subsidiary was being shuttered, but rather use of the DATABASE would be discontinued. Please clarify.

[Arizona Auto Insurance]

What truly scares me about any scandal in the insurance, mortgage, business, or banking industry is the feds see it as an opportunity to take over.