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New York State Attorney General Reaches Settlement Agreement with United Health and Ingenix
Settlement Agreement Will Impact Emergency Medicine
PINECREST, FL, JANUARY 16, 2009 - Attorney General Andrew M. Cuomo has reached an agreement
with UnitedHealth Group, Inc., the nation's second largest health insurer, to reform the nation's
healthcare reimbursement system. The settlement, reached January 13th, calls for UnitedHealth Group
to pay $50 million to fund a not-for-profit entity to develop and own a new, independent database
product to replace the Prevailing Health Charges System (PHCS) and Medical Data Research (MDR) database
products owned by UnitedHealth Group's subsidiary, Ingenix, Inc. The Ingenix databases are used by many
health plans to determine reimbursement rates for members treated by physicians outside of their managed
care networks. The investigation found that insurers who relied on the database underpaid various medical
services from 10% to 28%. Cuomo does intend to pursue other insurers who relied on the database to set
reimbursement rates.
"The issues at stake are complex, and it will be many months before the full affect can be determined,
but this settlement agreement will impact emergency medicine in a major way" said Jeffrey Bettinger, MD,
FACEP, Managing Member, BSA Healthcare. "Recently, the California Supreme Court issued a decision that prohibits
emergency physicians from balance billing patients who are covered by certain HMOs with whom the emergency
physician is not contracted, a decision loudly applauded by health insurance companies and denounced by
emergency physicians. This settlement agreement, between United Healthcare and the New York Attorney
General's office, may impact other states considering balance billing prohibitions. State legislators,
who until now, may have been sympathetic to balance billing prohibitions promoted my managed care insurance
companies will now see that the main reason that these companies are promoting balance billing prohibition
is to unilaterally reduce payment to emergency physicians in order to increase their own profits."
Please refer to the attached files for more information regarding the settlement.
The managing members of
BSA Healthcare have extensive experience in this area, having led efforts in Florida to address issues related
to balance billing prohibitions. If you have any questions about the settlement and how it may influence you
and your practice, please call 888-568-4993.
About BSA Healthcare
BSA Healthcare is a physician-owned healthcare consulting firm that helps hospitals, academic medical centers,
private medical practices, and outpatient facilities improve quality, financial performance, operations,
organizational structure, and strategic direction. Visit www.bsahealthcare.com or call 1-888-568-4993.
BSA Healthcare Services
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