Senator calls for new look at Ingenix database

A federal agency is asked to investigate health plans' use of the controversial data to set out-of-network rates.

By Emily Berry — Posted April 20, 2009

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U.S. Sen. Jay Rockefeller (D, W.Va.) has asked the Inspector General of the Office of Personnel Management to investigate whether federal employees were overcharged for health care because their plans use a database operated by UnitedHealth Group subsidiary Ingenix.

"I am concerned that federal employees participating in the Federal Employees Health Benefits Program may have been charged excessive out-of-pocket costs because of the health plans' use of the Ingenix database products to determine rates for out-of-network services," Rockefeller wrote in a note dated March 31.

Rockefeller wrote that he wants to know, going back 10 years, how many FEHB plans used Ingenix to set rates and how many federal employees were affected. More than 8 million employees, retirees and dependents are enrolled in FEHB health plans, private companies contracted to provide insurance coverage.

Rockefeller sent the letter following two rounds of Senate committee hearings in March over Ingenix and out-of-network pay. AMA President Nancy H. Nielsen, MD, PhD, was among those who testified before the Senate Committee on Commerce, Science, and Transportation, which Rockefeller chairs.

Ingenix Chief Executive Officer Andy Slavitt also testified. "During [New York Attorney General Andrew Cuomo's] review, his office raised a concern that Ingenix's ownership of the databases presented an inherent conflict of interest. We would like to make clear that there is an important difference between an inherent conflict and the actual practice of bias; the latter is something neither I, nor my employees, nor our parent company would ever tolerate."

Rockefeller was unconvinced. "I don't know, frankly, how you sleep at night," he told Slavitt and United President and CEO Stephen Hemsley.

Cuomo's office this year has settled with 10 insurers operating in New York that agreed to adopt a new system for setting out-of-network pay after an investigation revealed what the attorney general said was a rigged system that shortchanged doctors and patients. None of the companies has admitted wrongdoing.

The AMA and other medical societies in January settled a 9-year-old federal lawsuit with United over the Ingenix database for $350 million. The AMA and others also have sued Aetna, Cigna and WellPoint separately in federal court, citing underreimbursed claims by doctors. The health plans deny the allegations.

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External links

Sen. Jay Rockefeller's (D, W.Va.) letter requesting an investigation into how participants in the Federal Employees' Health Benefit Program were affected by insurers' use of Ingenix to set out-of-network rates. (link)

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