Well if you are a physician in Connecticut and were not sure who and what Ingenix is, you are now if you received a multitude of requests for patient records. Big question too, why are the letters not going out under the United Healthcare letterhead and why Ingenix? I might guess there’s a buck to be made here as that’s what Ingenix does, data services, business intelligence, algorithms and studies that determine who gets paid and how much. They made heaps and so did other insurance carriers until Andrew Cuomo went after them. Everything is a buck and profit with this part of United Healthcare and their services are entwined in so many facets of healthcare, and they say they fight fraud too, so which are they better at, fighting it or creating it? They also make a ton of money selling your medication records too, that come from pharmacy benefit managers and do not fall under the protection of HIPAA.
Before United gets the newly insured consumers perhaps they want the opportunity to “score” them first? That’s what the algorithms of Ingenix and companies like them do best. Now, on the other side of the coin, any compensation for the time for the doctors to yet add one more administrative task to their already overloaded red tape bureaucracy of dealing with insurers? Is the information on file with HealthNet not good enough? Insurance carriers will jump through hoops and stand on their heads to get more data to analyze as the big move now is to further develop behavioral underwriting.
Red Brick is a client of Ingenix (a wholly owned subsidiary of United Healthcare) that specializes in data, data, data and more data along with analysis and recommendations. Ingenix just settled a 9 year lawsuit with the AMA and there’s more suits in the works over the out of network compensation and probably more to come. In reading the Aetna financial news they claimed that 20 million of their troubles were due to the fact that they are no longer using the Ingenix data base and that is why they took the 20m hit.
The article states that the the group of patients they were seeking records for were the Medicare Advantage consumers, the ones they make bigger profit margins from as all the insurers have been reporting in the news of late, the government subsidized Advantage plans have been the most profitable. At any rate, doctors were urged to also make sure the requests were legitimate since they wheeled in on fax machines instead of a formalized letter in many cases. United and Ingenix according to this article just blew off the Connecticut Medical Society, who also happens to be suing the state over the buy out, has not responded from their request. BD
Feb. 6--Doctors around the state have been receiving "potentially deceptive" requests for hundreds of patient medical records from a company affiliated with UnitedHealth Group, an insurer that has been given state permission to acquire another insurer, HealthNet.
The Connecticut State Medical Society, the state's largest physician organization, announced late Friday it has warned physicians about the requests and that it has "significant concerns regarding the legitimacy of the letters." It said that on Monday it demanded that UnitedHealth and HealthNet stop these reviews and requests immediately, and that as of Friday afternoon had received no response.
Daryl Richards, spokesman for UnitedHealth, said the requests were made by Ingenix, a UnitedHealth subsidiary that provides health data review services to several insurers including both UnitedHealth and HealthNet, in keeping with standard practices and patient privacy laws. The requests pertain to claims of patients with Medicare Advantage, privatized Medicare plans provided by insurance companies.
The reviews are being done to ensure that the claims are "complete and accurate," he said.
Audrey Honig Geragosian, spokeswoman for the medical society, said the society has received hundreds calls from doctors with concerns about the requests. Some received requests for records for up to 100 patients.