JUL 3, 2009 5:20am ET

Related Links

JPMorgan Victim to Email Phishing Scam
August 25, 2014
Building an Advanced-Analytics Center of Excellence
August 25, 2014
Unleashing the Value of Advanced Analytics in Insurance
August 25, 2014

Web Seminars

Why Data Virtualization Can Save the Data Warehouse
September 17, 2014
Essential Guide to Using Data Virtualization for Big Data Analytics
September 24, 2014

Senate: Flawed Payment Data Widespread


The use of flawed databases operated by Ingenix Inc. to determine out-of-network health insurance reimbursement rates was widespread across the nation, according to a new report of the Senate Commerce, Science and Transportation Committee.

Not only did Ingenix scrub data it received from insurers to remove high charges in order to lower "usual and customary" rates on which reimbursement was determined, but the insurers also scrubbed high charges from their data before submitting it to Ingenix, according to the report.

"The results of these questionable statistical methods were estimates of 'usual and customary' charges that consistently skewed reimbursement rates downwards--in a direction that allowed insurers to reduce their claims payments," according to the Senate committee report. "The New York Attorney General concluded that the 'prevailing rates' Ingenix generated for doctor visits in New York were as much as 30% lower than the actual market rates for these services. In other words, insurance companies were paying only 70 cents on each dollar they owned their customers under the terms of their policies."

In recent months, several health insurers have signed agreements with New York Attorney General Andrew Cuomo to stop using the Ingenix databases. They also agreed, along with Ingenix, to contribute to building a new independent database for determining out-of-network reimbursement rates.

Several of the payers, including Ingenix corporate parent UnitedHealth Group, have acknowledged conflicts of interest in the Ingenix databases. Still, UnitedHealth Group CEO Steve Hemsley in March testimony before the Senate committee, defended the integrity of the data. "We want to make clear that we stand behind the integrity of the Ingenix data," he said in written testimony. "In addition, we stand by the way in which our insurance business, UnitedHealthcare, used the data to make reimbursement decisions. Our recent agreement with the New York Attorney General did not relate to the manipulation of data or other similar misconduct."

This article originally appeared on another SourceMedia Web site, Health Data Management.

Get access to this article and thousands more...

All Information Management articles are archived after 7 days. REGISTER NOW for unlimited access to all recently archived articles, as well as thousands of searchable stories. Registered Members also gain access to:

  • Full access to information-management.com including all searchable archived content
  • Exclusive E-Newsletters delivering the latest headlines to your inbox
  • Access to White Papers, Web Seminars, and Blog Discussions
  • Discounts to upcoming conferences & events
  • Uninterrupted access to all sponsored content, and MORE!

Already Registered?

Filed under:


Comments (0)

Be the first to comment on this post using the section below.

Add Your Comments:
You must be registered to post a comment.
Not Registered?
You must be registered to post a comment. Click here to register.
Already registered? Log in here
Please note you must now log in with your email address and password.
Login  |  My Account  |  White Papers  |  Web Seminars  |  Events |  Newsletters |  eBooks
Please note you must now log in with your email address and password.