The Dallas Morning News reports that the American Medical Association has joined doctors associations
from Texas and other states in suing health insurers Aetna Inc. and
Cigna Corp. over a database they say was rigged to underpay physicians
for more than a decade. Here are excerpts from the article:
The
lawsuits heap more criticism on Ingenix Inc. data that already has cost
UnitedHealth Group Inc. $350 million to settle a separate lawsuit
involving the AMA. Ingenix is a UnitedHealth subsidiary.
The
latest complaints accuse Aetna of deleting valid high charges from
figures contributed to an Ingenix database. They also accuse Cigna of
hiding "serious, systemic flaws" in the data.
Insurers use the data to determine "usual and customary rates" for care received outside their networks.
But
Aetna and Ingenix "cooked the books" and corrupted the database,
according to a complaint filed Monday in U.S. District Court in New
Jersey. That led to skewed data, which lowered the reimbursement
doctors received.
"It's time for Aetna and Cigna to stop this
unethical business practice that shocks our patients with unexpectedly
high bills for health care they thought they'd already paid for," said
Dr. Josie Williams, president of the Texas Medical Association and
assistant professor at Texas A&M University System Health Science
Center College of Medicine. "It's time for them to stop cheating
physicians and patients just to pad their own profits."
It
noted, for instance, that doctors in the expensive New York City market
charge on average $214 for a 15-minute, out-of-network office visit.
Health plans reimburse as much as $160 using the Ingenix database.
Medicare pays doctors $77 for the same visit.
Aetna
has already agreed to pay $20 million to help set up a new database
that will replace the one run by Ingenix. UnitedHealth also pledged
last month to give $50 million toward the database's creation.
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