New York Attorney General Issues New Subpoenas To Health Insurers In Fraud Investigation

Main Category: Health Insurance / Medical Insurance
Also Included In: Medical Malpractice / Litigation
Article Date: 10 Mar 2008 - 10:00 PDT

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New York Attorney General Andrew Cuomo (D) on Thursday said he issued new subpoenas to several health insurers as part of an ongoing fraud investigation, the AP/Houston Chronicle reports. In February, Cuomo announced that he would investigate whether insurers were using UnitedHealth Group-owned Ingenix to set unjustifiably low reimbursement rates for customers, which results in higher out-of-pocket costs for plan members seeking out-of-network care. Cuomo said, "Ingenix is a wholly owned subsidiary of the industry, and the company is determining the rates that the insurance companies use to reimburse consumers." He filed a notice in February to sue Ingenix but has not done so yet.

The subpoenas were sent to Aetna, Cigna, Empire Blue Cross Blue Shield, Excellus, UnitedHealth, WellPoint, and the combined GroupHealth and HIP Health Plan, as well as to a group of New York state HMOs. Cuomo is requesting all e-mail correspondence involving the companies' CEOs, CFOs, chief operating officers, presidents and employees supervising claims. He also requested any records that could challenge the accuracy of reimbursements he believes are too low.

In addition, Cuomo is investigating whether the insurers knew they were using artificially low reimbursement rates and whether the companies' investors were aware of the practice. According to Cuomo, "The CEOs are responsible for their corporations, and these actions had a significant impact on families all across the state." He added, "I believe consumers have been defrauded. I believe the companies have been allowed to do it nationwide. I believe there is a certain corporate arrogance to these companies."

The companies declined to comment on Cuomo's statements but said they will cooperate with the investigation (Gormley, AP/Houston Chronicle, 3/6).

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