Subpoenas issued to insurers in New York rate-setting probe

The New York attorney general wants to talk to several health plans that used data from UnitedHealth Group's subsidiary Ingenix to determine out-of-network payments.

By Emily Berry — Posted March 24, 2008

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New York Attorney General Andrew Cuomo has issued numerous subpoenas to health plans in the state as part of his investigation of a UnitedHealth Group subsidiary used by the plans to set out-of-network payment rates.

Cuomo's office issued 20 subpoenas March 6, including four to the CEOs of Aetna, Cigna, UnitedHealth Group and WellPoint, ordering them to testify in depositions about their companies' practices around out-of-network payments. The inquiry centers on United subsidiary Ingenix, which sells access to a database used by most insurers to set out-of-network reimbursement amounts known as "usual, customary and reasonable." The attorney general notified United of his intent to sue the company and Ingenix, but has not yet done so.

Cuomo alleges that Ingenix intentionally underset UCR rates to save money for its health plan clients, resulting in patients being stuck with a larger portion of their doctors' bills. United denies the allegations.

The office subpoenaed WellPoint subsidiary Empire BlueCross BlueShield, Excellus BlueCross BlueShield, Group Health Inc./Health Insurance Plan of Greater New York, as well as HMOs HealthNow New York (parent company of two New York Blues plans), MVP/Preferred Care, Capital District Physicians Health Plan and Independent Health.

The attorney general is seeking documents and correspondence related to the way the companies set out-of-network payments, spokesman Jeffrey Lerner said.

Representatives for United, Cigna, Aetna, CDPHP, MVP/Preferred Care and HealthNow all said that they were cooperating with the investigation.

A statement from Empire's President and CEO Mark Wagar said he was "surprised" at Cuomo's subpoena because "we have been diligent in our efforts to determine whether the information provided by Ingenix was accurate, and we were prepared to share data with the Attorney General's office in accordance with previously agreed to time frames .... [A]t this time, we have not found any evidence that our use of the Ingenix data was defective."

The American Medical Association/State Medical Societies Litigation Center, along with the Medical Society of the State of New York and the Missouri State Medical Assn., sued United and Metropolitan Life Insurance over the same issue in 2000. That lawsuit is pending in U.S. District Court in New York.

The AMA has said it welcomes Cuomo's investigation.

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