Navigation Links
AMA Commends N.Y. Investigation of Health Insurers
Date:2/13/2008

Remarks delivered today at a press conference hosted by New York Attorney General Andrew Cuomo to announce a suit against UnitedHealth Group, and a probe of 16 national health insurers regarding an alleged scheme to defraud consumers.

NEW YORK, Feb. 13 /PRNewswire-USNewswire/ -- The following is attributable to Nancy H. Nielsen, M.D., Ph.D., AMA President-elect:

"The investigation launched today by New York Attorney General Andrew Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members.

"UnitedHealth Group and other health insurers have shortchanged tens of millions of patients who agreed to pay higher premiums for access to their choice of physicians from outside a health insurer's network.

"These patients have a right to expect fair and accurate payment for services promised by health insurers. But at issue could be billions of dollars that health insurers have pocketed by paying treatment costs at less than what was promised.

"One way health insurers determine how much they will pay for medical services is by calculating the UCR -- a term that refers to "usual, customary, and reasonable" charges. As the name implies, these charges are essentially the "going rate" that physicians charge for their services in a given market.

"Instead of determining UCR amounts in a fair and evenhanded manner, UnitedHealth uses data that we contend pervasively understates UCR amounts. Unfortunately, there is no reason to think this is an isolated situation. In fact, the circumstances suggest that the practice of using skewed UCR amounts is widespread in the health insurance industry.

"By controlling and manipulating UCR calculations, health insurers can keep reimbursements artificially low. Health insurers have profited from skewed UCR data, while forcing patients to absorb a higher share of the costs passed on by the insurers. Patients who challenge the costs assigned by the insurer are met with a brick wall of secrecy. This effort to conceal the payment process ensures that patients and physicians don't have the necessary information to hold UnitedHealth accountable to its payment obligations.

"Despite repeated requests from patients and physicians, UnitedHealth Group has refused to specify how UCR amounts are determined. We believe UnitedHealth's UCR calculations can't withstand close scrutiny because they rely on flawed data and invalid statistical methods.

"In an era of increasing health care transparency, it is shocking and unacceptable for a health insurer to profit from deliberately withholding information from patients and physicians. The shroud of secrecy covering UnitedHealth's entire payment process must be lifted. There is no legitimate policy rationale behind the health insurer's refusal to provide information to physicians and patients. It serves only as a means for health plans to increase profits by keeping patients and physicians in the dark.

"This is one more example of UnitedHealth playing by its own rules without regard to state laws designed to protect patients and physicians. UnitedHealth has developed a track record of regulatory violations stretching from Monterey to Montauk.

"The state of California is seeking up to $1.3 billion in fines from UnitedHealth for more than 130,000 violations of state law. New York state officials took the unprecedented step of banning UnitedHealth from enrolling any new HMO customers in 2006 after the insurer repeatedly defied state regulations.

"The AMA greatly appreciates the Attorney General's interest and leadership in protecting consumers, and we offer our full cooperation in any effort to hold UnitedHealth accountable to New York state laws."


'/>"/>
SOURCE American Medical Association
Copyright©2008 PR Newswire.
All rights reserved

Related medicine news :

1. HCLA Commends President Bushs Strong and Continuing Commitment to Medical Liability Reform
2. Senate Finance Committee Recommends Ways That Medicare Can Enhance Current Physician Quality Reporting Initiative (PQRI)
3. AHIP Commends IOM for Recommending Comparative Effectiveness Program
4. Leading National Patient Advocacy Group Commends Insurance Industrys Recognition, Focus on Growing National Problem of Uninsured and Underinsured Americans
5. AMA Commends Independent Health for Joining Industry Shift on Physician Performance Measurement
6. FDA Advisory Committee Recommends Approval of KYNAPID(TM) for Acute Atrial Fibrillation
7. Datascope Recommends Shareholders Re-Elect its Two Incumbent Directors and Reject Ramius Opposition Slate
8. NCOA Commends Long Term Care Commission Report
9. FDA Advisory Committee Recommends Approval of Abbotts XIENCE(TM) V Drug Eluting Stent System
10. AMA Commends Aetna for Quality First Commitment
11. National Association of EMS Educators (NAEMSE) Recommends Screening for Carbon Monoxide Poisoning
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/26/2017)... ... 26, 2017 , ... NuevaCare, a leading home care agency based in San ... Alto, is proud to announce an important upgrade to its geographic information pages, starting ... close to home, and by having city-specific pages, NuevaCare is answering that information need. ...
(Date:2/26/2017)... ... February 26, 2017 , ... ODH, Inc.™ announced today it will exhibit ... Sheraton Pentagon City Hotel in Arlington, VA. ODH’s director of medical strategy, Candace Saldarini, ... to improve Medicaid population health management. , ODH will also have an exhibit booth ...
(Date:2/24/2017)... (PRWEB) , ... February 24, 2017 , ... ... its newly designed TaskMate Go. Core benefits and advantages built into the home ... a stylish, functional look and feel. Ability to gain the benefits embedded in ...
(Date:2/24/2017)... ... ... An in-depth computational analysis of genetic variants implicated in both schizophrenia and ... may explain why susceptibility to one of the disorders could place individuals at lower ... the journal npj Schizophrenia. , “There is a wealth of genomic data on ...
(Date:2/24/2017)... ... February 24, 2017 , ... With millions ... so critically important that we all are aware of our options and are ... proud to announce the launch of its newest edition of "Vision and Hearing" ...
Breaking Medicine News(10 mins):
(Date:2/27/2017)... Feb 27, 2017 Period October – December 2016 ... Operating result amounted to SEK -16.4 (-6.4) million Result after ... (-0.22) before and after dilution Cash flow from operating activities ... ... 0.4 (0.4) million Operating result amounted to SEK -39.5 (-29.5) ...
(Date:2/24/2017)... Research and Markets has announced the addition of the ... to 2025" report to their offering. ... The Global Wireless Health Market is ... next decade to reach approximately $330.5 billion by 2025. ... the given segments on global as well as regional levels presented ...
(Date:2/24/2017)... , Feb 24, 2017 Research and Markets ... and Strategies - 2016" report to their offering. ... The latest research Dry eye Drugs Price ... the global Dry eye market. The research answers the following questions: ... Dry eye and their clinical attributes? How are they positioned in the ...
Breaking Medicine Technology: