The American Medical Association (AMA) joined with individual physicians in filing separate class-action lawsuits against Aetna Health Inc and CIGNA Corporation on February 9, 2009. The AMA filed under claims that the two companies used rigged data to dramatically under-reimburse physicians. Multiple state medical associations also took legal action against the two significant primary insurance companies.
The two lawsuits were filed in New Jersey Federal court, contending that for more than 10 years the two insurance companies used a corrupt system to underpay physicians for out-of-network medical services and forced patients to pay an excessive portion of costs.
“We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without regard to patients, or the legitimate costs required to care for them,” says AMA president Nancy H. Nielsen, MD.
The complaints charge that Aetna and Cigna relied on skewed data provided by Ingenix, a subsidiary of UnitedHealth Group, to set reimbursement rates for out-of-network care. A recent investigation launched by New York Attorney General Andrew Cuomo found that the Ingenix data is intentionally manipulated to allow health plans to scam physicians by shortchanging reimbursements on medical bills.
“Through our lawsuits, the AMA and our partner medical societies seek to reform the payment systems used by Aetna and CIGNA by ending their dependence on the Ingenix database,” says Nielsen. “The lawsuits also seek relief for physicians who were seriously harmed by Aetna and CIGNA through the insurers’ long-term use of the flawed Ingenix database.”