Ingenix collects provider health care charges in developing cost databases that insurers use in determining what are usual-and-customary fees. Several insurers in recent months have agreed to stop using the databases amid an investigation by New York Attorney General Andrew Cuomo into whether the practice resulted in artificially low reimbursement rates for out-of-network services.
“There is an important difference between an inherent conflict and the actual practice of bias—the latter is something neither I nor my employees nor our parent company would ever tolerate,” Ingenix CEO Andy Slavitt said at a Senate Commerce Committee hearing.
Slavitt said that while the company was “myopic” in not recognizing the perceived conflict of interest, it disagrees with any allegations of fraud in the way it collected and provided information.
Committee Chairman John D. Rockefeller IV, D-West Virginia, said Ingenix’s practices resulted in usual-and-customary charges being understated and health care plan enrollees who went outside their health care plans’ managed care network paying more than they should have.
Filed by Jerry Geisel of Business Insurance, a sister publication of Workforce Management. To comment, e-mail email@example.com.
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