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NY AG Cuomo Announces Industry-wide Investigation Into Health Insurers' Fraudulent Reimbursement Scheme

Press release: “Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation’s largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country.

Cuomo also announced that he has issued 16 subpoenas to the nation’s largest health insurance companies including Aetna, CIGNA, and Empire BlueCross BlueShield, and that he intends to file suit against Ingenix, Inc, its parent UnitedHealth Group, and three additional subsidiaries.

The six-month investigation found that Ingenix operates a defective and manipulated database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses. Further, the investigation found that two subsidiaries of United (the “United insurers”) dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix.

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