The two lawsuits, filed late yesterday in New Jersey federal court, contend that for more than a decade the health insurers used a fraudulent system to underpay physicians for out-of-network medical services, and forced patients to pay a greater portion of the costs, the AMA says.
"We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without regard to patients, or the legitimate costs required to care for them," says AMA President Nancy Nielsen.
The AMA charges that Aetna and CIGNA used skewed data provided by Ingenix, a subsidiary of UnitedHealth Group that is planned for closure, to set reimbursement rates for out-of-network care. Evidence from a recent investigation launched by New York Attorney General Andrew Cuomo held that the Ingenix data was intentionally manipulated to allow health plans to scam physicians by shortchanging reimbursements on medical bills.
"Through our lawsuits, the AMA and our partner medical societies seek to reform the payment systems used by Aetna and CIGNA by ending their dependence on the Ingenix database," Nielsen says. "The lawsuits also seek relief for physicians who were seriously harmed by Aetna and CIGNA through the insurers' long-term use of the flawed Ingenix database."
At that time, Cuomo also reached an agreement with Aetna to pay $20 million to help establish an independent database used for calculating rates. This pact adds to the $50 million UnitedHealth previously agreed to pay to fund the database.
