If you are not up to date, this is the same company (wholly owned subsidiary of United Healthcare) that had the data base that calculated the short payments United, Blue Cross, Healthnet and other insurers who used it. The New York Attorney General pursued the case and millions now available to claim.
Why do we give contracts to run algorithms to the very same company that ran a data base to pay short for 15 years is a question that comes to mind. This is one of the reasons that “trust” for the health insurance industry is so low. Can we trust them now? There’s more lawsuits in the tumbler as well over the same data base used for calculations.
Are we hiring the hacker as it would be stated when it comes to security with computers and networks?
Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana
We all know criminals do a better job at billing as most have one focus only and that is fraud and granted audits are needed to double check and go over what has been paid and billed, no problem there with that function.
When looking for healthcare fraud, it may look great on the numbers but outside agencies that go beyond just algorithms are still needed to find fraud, otherwise many doctors and hospitals get hit with “false positives” if this is the only means used. We have seen a lot of that tied up in our legal system. The incentives here are that the company will get paid on a percentage of what they find. BD
The state of Alabama has awarded Ingenix Inc. a two-year contract to review claims and identify any funds owed to the state.
The Alabama Medicaid Agency, nationally recognized for its payment and eligibility accuracy, will work with Eden Prairie-based Ingenix on a focused post-payment review of claims filed for the past two years by all Alabama-based health care provider groups, including hospitals, physicians, dentists, pharmacies, medical equipment companies and home health care providers.
Under the terms of the deal, Ingenix will be paid a percentage of any incorrect payments identified and recovered, rather than a standard flat fee.