WellPoint Sued by Physicians

Indianapolis-based WellPoint Inc. has been sued in Los Angeles federal court by several medical societies including the American Medical Association (AMA). The suit emanates from WellPoint’s use of the Ingenix database, which the plaintiffs contend was used to set artificially low reimbursement rates for out-of-network care. Last month Hartford, Conn.-based Aetna Health Inc. and Philadelphia-based CIGNA Corp. were hit with similar lawsuits.

"Physicians will not tolerate an apparent conspiracy that allows health insurers to play by their own rules without regard to patients, or the legitimate costs required to care for them," says AMA President Nancy H. Nielsen, M.D.

The lawsuits come on the heels of announcements from New York Attorney General Andrew Cuomo that several health insurers including, Aetna and CIGNA, had agreed to stop using the Ingenix database and would help establish an independent database used for calculating rates. Hartford, Conn.-based UnitedHealth Group Inc., a user of the database and parent company of Ingenix Inc., also settled out of court with Cuomo.

Nielsen says despite the settlements, the lawsuits will proceed. "Now that the underlying scheme has been exposed, health insurers are doing the right thing by cutting their ties with the flawed Ingenix database,” she says. “However, serious damages resulting from prior use of the Ingenix database still need to be addressed.”

In addition to the AMA, litigants include the California Medical Association, Connecticut State Medical Society, Medical Association of Georgia and North Carolina Medical Society.