Aug 17, 2017

Cuomo to Investigate Major Health Insurers


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11/17/2008
Brian S. King
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UnitedHealth Group is a big company. It owns a lot of smaller companies. Most of them are health insurers doing business in particular states or regions. Another company that UHG owns, Ingenix, gathers information about healthcare costs from various healthcare providers across the country. Ingenix then sells that data to insurers, large self funded employer sponsored benefit plans and third party administrators.

Andrew Cuomo, Attorney General for New York, issued a press release today announcing an investigation of health insurer fraud. The press release is here. It seems that Attorney General Cuomo has uncovered information that causes him to believe certain United insurers have been coordinating efforts with Ingenix to artificially rig information about healthcare costs in a way that improperly shifts costs from the health insurers to the insureds.

This is welcome news. I’m not surprised in the least that the easy access to Ingenix information ends up, sooner or later, combining with the profit motive to led to manipulation and abuse. And my personal experience dealing with a variety of health insurers and providers over a number of years leaves me unsurprised that United is the target of this investigation.

To be fair, United isn’t Cuomo’s only target; a number of other large health insurers such as Aetna, CIGNA and Empire Blue Cross Blue Shield are also being investigated by the State of New York.

It’s interesting: Cuomo refers to a lack of transparency, the unfair coordination of efforts between health insurers and Ingenix to improperly deal to their own advantage at the expense of consumers, broken insurer promises to insureds, and a lack of independence in setting reasonable and customary rates of reimbursement. We hear a lot about fraudulent activities of healthcare providers. But there’s plenty of fraud among health insurers too. It’s just that often it is a lot easier for them to hide it.



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