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Doctors Groups Sue Aetna and Cigna, Alleging Rigged Database Underpaid Physicians

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.”

The insurer said prices charged by doctors are part of the problem.

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.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

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