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Feb 4, 2009 10:32 pm US/Central
Health Care Probe Leads To Upstate NY Insurer
MINNEAPOLIS (AP) ―
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Attorney General Andrew Cuomo recently announced a deal with UnitedHealth to shut down the Ingenix database (File)
AP
Attorney General Andrew Cuomo wants information from officials at an upstate New York health insurance company as he continues a probe into lowballed reimbursements for patients' out-of-network care.
The CEO and directors of the Capital District Physician's Health Plan must submit testimony about the use of databases operated by Ingenix Inc., a subsidiary of Minneapolis-based UnitedHealth Group.
Insurers reported claims information to Ingenix, which created databases used to determine the "usual and customary" payments for patients' care outside their insurance network.
Cuomo recently announced a deal with UnitedHealth to shut down the Ingenix database and address allegations data were manipulated to push rates artificially low, reducing insurers' payments to patients.
Dr. John Bennett, CDPHP's president and CEO, said Wednesday the company has been cooperating with Cuomo's office.
"As a health plan conducting primarily HMO business, CDPHP has little occasion to deal with out-of-network claims on behalf of its members," Bennett said. "In fact, fewer than five percent of the CDPHP commercially-insured members are enrolled in a product with an out-of-network benefit."
He said CDPHP made little use of Ingenix data and did not share information with the company.
"CDPHP's attempts to minimize the fraud and damage done to their members further manifests their lack of responsibility and disregard for basic fairness," said John Milgrim, a spokesman for Cuomo. "CDPHP members were defrauded and the fraud continues and we will not stop until it ceases."
(© 2009 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)
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