AMA sues Aetna, Cigna for under-reimbursing docs
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The two lawsuits, filed Monday in N.J. federal court, contend that for more than a decade the two health insurance companies "used a corrupt system to underpay physicians for out-of-network medical services and forced patients to pay an excessive portion of the costs," according to the AMA.
"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," said AMA President Nancy H. Nielsen, MD.
The complaints charge Aetna and Cigna with relying on skewed data provided by UnitedHealth Group subsidiary Ingenix to set reimbursement rates for out-of-network care. Evidence from 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.
In January, Aetna agreed to pay $20 million to settle accusations from the state of New York that it and other payors used Ingenix to shortchange doctors and hospitals on reimbursements for out-of-network services.
"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," Nielsen said. "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."