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Fraud lawsuit for UnitedHealth

18th February 2008

Authorities in the United States have announced they will sue leading healthcare operator UnitedHealth Group for alleged fraud relating to insurance reimbursements for medical bills.

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Andrew Cuomo, attorney-general for New York state, made the announcement following a six-month investigation into the working practices of UnitedHealth and its subsidiaries, including the medial billing information provider, Ingenix.

Cuomo issued a total of 16 subpoenas across the group of companies, alleging that Ingenix deliberately underestimated the cost of healthcare products and procedures in cases where patients were using services which were not part of the insurer's network.

He said the result was that ordinary people had been left with a higher-than-reasonable share of their medical bills, a factor which might discourage them from seeking treatment if they needed it.

UnitedHealth is just recovering from a US$468 million settlement by its chief executive William McGuire, who was alleged to have back-dated stock options.

Cuomo has stepped up efforts to police the US healthcare industry in recent months, opening an investigation last month into allegations that Merck and Schering-Plough concealed unfavourable clinical trial results related to their jointly developed cholesterol drug Vytorin.

Access to equitable and affordable healthcare has become a major issue in the current US presidential campaign.

Cuomo said the result of the Ingenix case was that real people got stuck with excessive bills. He accused Ingenix of operating a defective and manipulated datbase.

Most major health insurers rely on the Ingenix database to decide how much to pay out on visits to the doctor, medical treatments and procedures and prescriptions which fall outside their own provider networks.

Among those receiving subpoenas in the case were insurers Aetna, Cigna and Empire BlueCross BlueShield.

The lawsuit will be filed against UnitedHealth Group and subsidiaries United HealthCare Insurance Company of New York, United Healthcare of New York, United Healthcare Services and Ingenix.

A statement from the company said it was in talks with the attorney-general's office, and would continue to cooperate fully with the authorities.

 

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Article Information

Title: Fraud lawsuit for UnitedHealth
Author: Luisetta Mudie
Article Id: 5644
Date Added: 18th Feb 2008

Sources

The Financial Times

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