A leader in the health insurance industry, Oxford Insurance and its parent company UnitedHealth Group, agreed to pay a $50 million settlement for paying less medical reimbursement by overcharging patients due to “defective and manipulative” numbers, according to New York Attorney General Andrew Cuomo.

After receiving hundreds of complaints about Oxford Insurance and UnitedHealth Group, the New York attorney general’s office began investigating claims from companies that rely on independent research to determine reimbursement rates.

The research firm, Ingenix, develops the database used to determine UnitedHealth’s insurance reimbursement rates. Ingenix is owned by UnitedHealth. Under the settlement, UnitedHealth can no longer use Ingenix’s database as a means to set reimbursement rates for out-of-pocket medical expenses; and $50 million will be used to fund a nonprofit independent database to determine reimbursement rates.

Find related articles on MSN Today and Reuters Web sites.

7 Responses to “Overcharges Cost Insurance Companies $50 Million”

1. RSRM Says:
   January 21st, 2009 at 1:59 pm

   Why were the insurance companies not required to REFUND the stolen funds to the people it robbed them from- the PATIENTS?
   Why were the funds tiven back to BUSINESS vs the workiung man patients?
   I think Senate Finance Comitte on Healthcare reform needs to take a look at this, so not only business needs are met (eg $50 million will be used to fund a nonprofit independent database to determine reimbursement rates.) but WORKING man gets funds back there were ROBBED of!
   What a disgrace to our profession!
   More corporate greed.
   And did this happen in ALL states or just New York? What is being done to help the patients recover their funds?

   This article did not go far enough in sharing what was done to fight for the victims right, eg the patients. : overcharging patients

2. marisela amador Says:
   January 21st, 2009 at 4:14 pm

   What about providers in California. We have always had problems collecting payments from United HealthCare. On top of that it is very inconsistent with payments and very Consistent in denying payments incorrectly. We always had problems with this insurance and still do to the date do. What can a gruop provider do in this case?

3. Sherry Gann, CPC Says:
   January 22nd, 2009 at 8:45 am

   I would appricate it if AAPC would gather additional information regarding United HealthCare issue in New York. I agree that the Senate Finance Commitee on Healthcare reform should be taking a close look at this. United HealthCare has been issued several judgements against them in different states. How do we get to the source? How does one approach the goverment with complaints with insurance carriers like this?

4. B Saenz, CPC Says:
   January 22nd, 2009 at 11:52 am

   UHC in the N.Va area is HORRIBLE. Well said by Marisela, they consistently deny clean claims for no legitimate reason. We have to APPEAL for their error in denying the claim or not paying the negotiated amount. Appeals are a joke. We call repeatedly and get transferred to “rapid resolutions departmart”, now that is the biggest joke, there is nothing rapid about it and rarely a resolution. I recently sent a batch of unresolved appeals to the Virginia State Insurance Commissioner, and SURPRISE, UHC paid those claims with 10 days, after a year of our calls and letters to UHC. I will routinely be filing a complaint with our state insurance commissioner, maybe someone will look at the fraud within UHC.

5. J Lawson Says:
   January 22nd, 2009 at 2:34 pm

   It goes without dispute that the victims of this UHC case deserve compensation. It also goes without dispute that UHC is an extremely difficult company to deal with. However, I don’t think they deserve to take on the burden of this hit singlehandedly as far as the subject of overcharging. I would like to know who is holding providers responsible to bill appropriately for charges? Sure, if contracted with a particular, they can bill as much as they want and only get paid their contracted allowable. But if not, they roll the dice and see how much they can get away with billing without regard for the actual cost of the service provided! With this type of billing practice you end up with the same victims as with the UHC members because its the patients who end up having to pick up the 40 or 60% coinsurance. This may not be the most effective area to post this concern, but at the very least, it is a ‘concern. So, if there is any feedback on that, I would love to hear it.

6. D Nelson Says:
   January 26th, 2009 at 3:22 pm

   To say that Doctors are as much blame as the insurance is not true, yes we doctors bill higher that insurance pays, but if we don’t, then the follow years are cut even more, because what we bill, is how they base futher payment rates, if you are a par. doctor, then most of what you charge is wrote off, and the patient only paye 40 or 60% of the allowable, which in UHC cases is poor to say the lest, and you have to fight for that. The Doctors have to play by the rules set into play by the insurance and medicare, but the insurance companys can play by what ever rule they want, and do, and change the rules often, it is about time that an insurance company finds out that the Doctors, and Patients are not going to take it any more, and I hope that other insurance companys take note and change their ways before they are caught as well..I do believe that the Patient’s should be the ones benifiting from the settlement.

7. T Muck Says:
   March 5th, 2009 at 11:04 am

   Its sad to me to see so much frustration over payment for non par services. To answer others questions, UHC/Oxford has also settled a class action law suit to reimburse members the difference in the UCR rate UHC/Oxford set vs whatever UCR rate is/will be determind by the NYG settlement. I .myself and pleased to see this non profit orginization being set up to set a standard for UCR that can be used by all carriers. It should allow non par providers to more accurately let their patients know ahead of time what services are going to cost them, which should allow the patients to make better decisions about non par services

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