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Tuesday, July 16, 2024

Medical Association Sues WellPoint Over Database

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The American Medical Association is suing another large health insurer over what it claims was a scheme to underpay doctors for out-of-network medical claims.

The AMA joined the Medical Association of Georgia and other medical societies in filing a lawsuit Wednesday in a Los Angeles federal court against Indianapolis-based WellPoint Inc. The lawsuit accuses the insurer of conspiring to use a much-maligned database maintained by Ingenix Inc. to set artificially low reimbursement rates.
The AMA said in a statement that the underpayment created higher bills for patients.
A statement from WellPoint said the insurer was reviewing the complaint and was “unable to comment further at this time.”
“This lawsuit is part of our ongoing legal advocacy campaign to protect physicians and their patients in Georgia,” said Medical Association of Georgia general counsel Donald J. Palmisano Jr. “This kind of vigilance ultimately results in a better health care system in the state.”
The case is similar to lawsuits filed last month against WellPoint competitors Hartford, Conn.-based Aetna Inc. and Philadelphia-based Cigna Corp.
Earlier this year, Ingenix’s parent company, Minnetonka, Minn.-based UnitedHealth Group Inc., said it will pay $350 million to settle a long-standing AMA lawsuit over price-fixing and the out-of-network claims. That settlement awaits a judge’s approval.
The database operated by Ingenix, a UnitedHealth subsidiary, also has attracted other lawsuits and an investigation by the New York attorney general’s office.
UnitedHealth agreed in January to close the database and contribute $20 million toward the creation of a new one. Aetna has agreed to pay $20 million toward the database creation, and the attorney general’s office has said WellPoint will chip in $10 million.
Insurers contributed claims information to the Ingenix databases, and then used those numbers to determine “usual and customary” payment rates for care patients seek outside their insurance network.
But industry representatives have said they use more than the Ingenix database to figure out-of-network reimbursement, and doctor rates that vary widely across the country contribute to medical cost problems.

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