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Donald A. Caminiti
Donald A. Caminiti
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Consumer Fraud Medical Reimbursement

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SAN FRANCISCO (Thomson Financial) – The New York Attorney General’s
Office said Wednesday it plans to file suit against Ingenix Inc., its
parent UnitedHealth Group (nyse: UNH – news – people ), and three
additional subsidiaries, as part of an investigation into a ‘scheme by
health insurers to defraud consumers by manipulating reimbursement

In addition, New York Attorney General Andrew Cuomo said he has issued
16 subpoenas to health insurance companies, including Aetna Inc. (nyse:
AET – news – people ), Cigna Corp. (nyse: CI – news – people ), and
WellPoint (nyse: WLP – news – people )’s Empire BlueCross BlueShield.

In a news release, Cuomo said a six-month investigation found that
Ingenix operates a ‘defective and manipulated database that most major
health insurance companies use to set reimbursement rates for
out-of-network medical expenses. Further, the investigation found that
two subsidiaries of United dramatically under-reimbursed their members
for out-of-network medical expenses by using data provided by Ingenix.’

Cuomo said the subpoenas to the health insurers request documents
showing how the companies compute reasonable and customary rates, copies
of member complaints and appeals, and communications with members and
between Ingenix and the insurer on the issue.