Physician organizations, state regulators and U.S. Senators brought evidence of UnitedHealth’s improper business practices to the attention of former New York Attorney General Andrew Cuomo in 2008. At issue was the use of flawed data by UnitedHealth to justify lower reimbursement rates for physicians for out-of-network services. Mr. Cuomo’s investigation confirmed the abuses and led several major insurers to agree to meaningful reforms and to fund a new, independent system that can be used to accurately set usual, customary and reasonable rates. In the settlement agreement, UnitedHealth admitted no wrongdoing and terminated use of the Ingenix database.
The settlement led to a new FAIR Health database, which publicly reports the fair rate for any given out-of-network services. FAIR stands for “Fair and Independent Research.”
“Patients and physicians will be able to go online to see how much a particular service is likely to cost, and how much the insurer is willing to pay, before the patient even sets foot inside the doctor’s office,” AMA President Peter W. Carmel, MD, said.
Related articles and documents:
Click here for details about the settlement between UnitedHealth and former New York Attorney General Andrew Cuomo.
Read the AMA news release, Court Approves Award Payments in AMA Legal Battle Against UnitedHealth
UnitedHealth Group Agrees to Settlements (Bulletin, 1-16-09)
Ingenix Lawsuit Filed (Bulletin, 5-30-08)