:: Class Actions Suits Alleged Improper Reimbursement Of Out Of Network Providers

I have been reporting the highlights of the Ingenix database controversy which has been at the center of investigation by the New York Attorney General and several significant lawsuits. According to the allegations, the use of a database operated by Ingenix, a subsidiary of United Health Group, has resulted in improper reimbursements of out of network medical providers.

Two new cases involving the Ingenix database have been filed in the New Jersey federal district court, one against CIGNA and the other against Aetna. The plaintiffs are the AMA, several state medical associations and several individual physicians. The plaintiffs seek class action status for the litigation, and base their claims on RICO, ERISA and the Sherman Act. I uploaded the complaints here.

Note: The controversy led to a significant settlement in the Health Net litigation discussed in :: Health Net Settlement At $215 Million May Set Class Action Record. As I noted in :: PHCS Provider Reimbursement Controversy Affects ERISA Self-Funded Health Plans, the case could have broarder implications for the self-funded health plan community. The reason – many claims administrators have relied upon the data in dispute – not just the large MCO’s.