Bloomberg News (2/10, Heine) reported that the American Medical Association and several state associations have filed lawsuits against "Aetna Health Inc. and Cigna Corp., alleging the insurers used 'a corrupt system' to underpay physicians and patients." The associations claim that Aetna and Cigna "used a UnitedHealth Group Inc. subsidiary's database rigged to cheat doctors and patients for out-of-network medical expenses." Last month, UnitedHealth "agreed...to pay $400 million to settle allegations it underpaid doctors and patients for 15 years by using" the database, which "minimized payments for services by doctors outside insurance company networks." In a related settlement with New York State, Aetna agreed to pay $20 million.
But now, Aetna is being accused "of deleting valid high charges from figures contributed to" the database, the AP (2/11) adds. Similarly, Cigna faces allegations of "hiding 'serious, systemic flaws' in the data." In a complaint filed Monday in US District Court for the District of New Jersey, the AMA argued that "Aetna and Ingenix 'cooked the books' and corrupted the database," which "lowered the reimbursement doctors received." The "skewed data" in turn "strained physician-patient relationships," the suit noted.
AMA President Nancy Nielsen, M.D., Ph.D., stated that the medical groups "seek to reform the payment systems used by Aetna and Cigna by ending their dependence on the Ingenix database," Forbes (2/11, LaMotta) notes. She added that the suits "also seek relief for physicians who were seriously harmed by" the two insurers through their "long-term use of the flawed Ingenix database." For its part, Cigna said that "its 'payments to out-of-network doctors are robust and fair, and greater transparency in regards to physician pricing will prove that point." The reimbursement "discrepancy" was originally uncovered "during New York State Attorney General Andrew Cuomo's Ingenix investigation."
Still, the settlements resolving Cuomo's allegations "didn't include any restitution for physicians," the Hartford Courant (2/11, Levick) points out. Instead, that "money will be used to create a new database to replace the...one run by Ingenix." The suits against Aetna and Cigna claim the two insurers "violated the Racketeer Influenced and Corrupt Organizations Act, the Sherman Antitrust Act, and the Employee Retirement Insurance Security Act." According to an Aetna spokeswoman, the company is "disappointed the medical community has chosen to litigate on top of already pending consumer litigation on the topic."
According to Healthcare IT News (2/10, Merrill), "The Litigation Center of the AMA and State Medical Societies is supporting the lawsuits in partnership with the Connecticut State Medical Society, Medical Society of New Jersey, Medical Society of the State of New York, North Carolina Medical Society and Texas Medical Association."
The Wall Street Journal (2/10, Goldstein) Health Blog, the Austin American-Statesman (2/10, MacLaggan), Texas' Star-Telegram (2/11, Perotin), the Philadelphia Business Journal (2/11), and the Harford (CT) Business Journal (2/10) also covered the story.
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