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AP / NYT June 25 2009 (Insurance Companies’) Database Takes Patients for Billions, Study Finds (MC)

Database Takes Patients for Billions, Study Finds

Published: Thursday, June 25, 2009 at 5:13 a.m.
Last Modified: Thursday, June 25, 2009 at 5:13 a.m.

WASHINGTON (AP) — Congressional investigators said Wednesday that two-thirds of the nation’s health insurance industry used a faulty database that overcharged patients for seeing doctors outside their insurance network, costing them billions of dollars in inflated bills.

The flawed database was operated by Ingenix, a subsidiary of the health insurer UnitedHealth Group, which agreed in January to pay $350 million to settle allegations that it deliberately kept rates low to underpay doctors, driving up expenses for patients.

UnitedHealth has admitted no wrongdoing in its handling of Ingenix, though it agreed to close the database and help pay for a new one operated by a nonprofit group.

An investigation by Senator John D. Rockefeller IV, Democrat of West Virginia, shows that nearly 20 regional and national insurers also used Ingenix data.

A continuing investigation by the New York attorney general, Andrew M. Cuomo, previously focused on the use of Ingenix data by only a handful of top insurers, including Aetna, Wellpoint and Cigna. About a dozen insurers, including UnitedHealth, have reached settlements with Mr. Cuomo.

More than 100 million Americans have plans that allow them to see doctors who are not part of their insurance network. For more than a decade, insurers submitted data to Ingenix to determine the typical cost for care received in such visits.

But Congressional investigators say companies would deliberately skew data to underestimate the costs of medical services, leaving patients to pay more in out-of-pocket expenses.

“The result of this practice is that American consumers have paid billions of dollars for health care services that their insurance companies should have paid,” according to the report of the Senate Commerce Committee’s investigative staff.