How many companies used the Ingenix Data Base one has to question.  While currentimage Acting Director of Medicare, Andy Slavitt was the CEO of Ingenix it appears he was quite busy.  This case, as you can read below per a recent decsion is now allowing doctors to cotninue with their case for the use of the flawed Ingenix Data Base.  Upon taking the position to run Medicare, HHS Secretary Burwell was able to get an unprecedented pardons in place for Mr. Slavitt to avoid all these lawsuits.  Does that set well with you?  It happened.

Connecticut General Life is the primary focus here with Cigna being the insurer providing the reimbursement.  This change probably hits Cigna at maybe not a good time when they are trying to merge with Anthem one could say, although there a lot more to the complex merge as well.  Cigna paid the claims, and thus the ruling is to now allow the case to proceed.  Last year, this Ingenix lawsuit was just settled as well with surgical centers also being short payed by Ingenix.  Ingenix had a name change to Optum Insights a couple years ago and I think all the lawsuits might have had something to do with that. 

Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…

In addition, this case with Ingenix just settled last year as well.

Ingenix (Optum-United Healthcare) Lawsuits Still Bouncing Around Out There–One Recently Settled in New Jersey With Horizon Blue Cross Blue Shield That Was Still Using the Flawed and Corrupt Data Base for Out of Network Payment Calculations

In addition, this group of lawyers in New York appears to be investigating the potential of another lawsuit with United, relating back again to payment of claims.

Law Firm Investigating UnitedHealthCare Claim Payments in New York Stating Under-Reimbursement By Manipulating Algorithmic Benefit Calculations…

A couple years ago, and it received very little publicity, the Supreme Court put out a ruling allowing doctors, imageto be able to group to worth together on such cases of unfair business practices as well. 

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

Almost all the major insurers were hit with the under payment legal cases as they were all licensing the use of the Ingenix Data Base that allowed calculations to short pay doctors and patients for out of network claims.  Aetna ended up waiting long enough and in the end weaseled out of their payments with some quick work by the company that somehow showed a lack of interest had developed.

Aetna Payment of $120 Million To Settle 15 Year Ingenix/United HealthCare Out of Network Erroneous Payment Algorithms Cuts Income for 4th Quarter

The big case of course that everyone may remember was the large class action suit that the AMA filed against Ingenix and won against United Healthcare Ingenix, and their CEO at the time, current CMS Acting Director Andy Slavitt.  The post was Chapter 19 of my old Killer Algorithms series to where I wrote about algorithms and formulas attacking consumers with either denying access or taking more money. 

AMA Announces Doctors And Patients Can Expect To See the UnitedHealthCare/IngenixClass Action Settlement Checks In the Mail Soon - Out of Network Short Payments–Attack of the Killer Algorithms Chapter 19

Ingenix itself was very busy as a subsidiary of United Healthcare securing Health IT contracts and buying up other companies as well.  As a matter of fact, all the bogus “medication prediction scoring” that we are all subject to when filling a prescription was all started with Ingenix algorithms being licensed to Express Scripts in 2010.  I call it bogus as I am referring to the prediction portion of this and not the actual monitoring of hard data.  If you look at the 300 metrics used by Express Scripts and some of the other pharmacy benefit managers with their proprietary calculations, they have nothing to do with taking your prescriptions and predict with flawed calculations on whether or not you will be compliant.  As an example, if you have kids, that’s one bad ding for your score. 

Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On IngenixAlgorithms–We Want the Revenue Please Don’t Stop

So back on track with Cigna here, they can’t seem to get out of being associated with United Healthcare either with some of their business.  United Healthcare is racking in big pharmacy benefit money as their acquistion of Catamaran turned United into the Cigna pharmacy benefit manager.  If I were Cigna running an insurance business I’m not sure I would be too happy with that with a competitor now running the pharmacy benefit end of the business?  It’s been stated that the Anthem/Cigna merge may not complete until 2017. 

United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups

So this case is rolling along, and the judge did decide that individual doctors and medical associations can’t file additional claims, and nor can it turn into a class action suit, but the current plaintiffs have the OK to collect from Cigna on the use, once of the flawed and corrupted Ingenix data calculations for paying doctors.  I sometimes wonder how much money Ingenix/United Healthcare really racked in from all of this as it went on for 15 years, had to be a bunch with all the licensing to so many other insurers as well. 

Ingenix (Optum Insights) folks have been hanging around Washington DC for quite a while and you can kind of see this going back to HHS just gushing over their “Reach for The Top” model, link below from 2010.  It contains pretty much all the elements CMS is pushing and marketing today, Population Health, paying doctors less and so forth, so the influence and math models and algorithmic plan association here leaves no doubt and perhaps all these models is what maybe convinced Secretary Burwell that in addition to all the Ingenix lawsuits that Slavitt was the correct person to run Medicare?  Go figure I guess.  We all knew before Burwell we had the affliction of the Sebelius Syndrome with her out of reality perceptions and chasing those Algo Faires too for perceived solutions.    BD 

"Reach for the Top" Program Combines Prototype from Ingenix (A Wholly Owned Subsidiary of United Healthcare) for Public/Private Community Health Data on HHS.Gov Site

May 2 — Out-of-network health-care providers have ERISA standing to continue with their lawsuit accusing Connecticut General Life Insurance Co. of using a manipulated database to determine their services fees, the U.S. Court of Appeals for the Third Circuit ruled. In the May 2 unpublished opinion, Judge Thomas I. Vanaskie reversed in part the district court decision that had seemingly put an end to a decadelong litigation. Vanaskie remanded the case to the district court, holding that the providers had sufficiently pleaded the existence of a valid assignment to support derivative standing under the Employee Retirement Income Security Act.

The proposed class action was originally brought by medical providers, individual subscribers and 14 medical associations, alleging that out-of-network services were underpaid because of flawed “usual, customary and reasonable” (UCR) rate data provided by Ingenix Inc.

The providers' allegation that they received from CIGNA insureds an assignment of benefits or a claim assignment through which they were paid directly by CIGNA was sufficient to plead the existence of a valid assignment to support derivative standing, the court said.


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