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W.Va. senator holds UnitedHealth's feet to fire
Jay Rockefeller says that UnitedHealth underpaid for out-of-network services and that patients overpaid.
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WASHINGTON - Sen. Jay Rockefeller, D-W.Va., aimed scathing criticism at Minnetonka health insurer UnitedHealth Group Inc. on Monday, saying it engaged in collusion to pay less for health care services provided outside its network.
Rockefeller, who chairs the Senate Commerce Committee, plans to hold a hearing today in which he says he intends to take UnitedHealth to task on its past billing practices for services sought by patients outside its insurance network. The company's chief executive, Stephen Hemsley, is set to testify at the hearing.
UnitedHealth reached a settlement with the New York attorney general's office earlier this year to resolve charges that one of its subsidiaries, Ingenix Inc., drew up billing rates that underpaid hospitals and doctors for out-of-network care, which costs more for patients than care within an insurer's coverage area. The result, according to Rockefeller and others, is that patients paid far too much for out-of-network coverage.
"The insurance company is paying less as they return to the hospital or to the doctor, which means the patient, unbeknownst to the patient, has to pick up the difference," Rockefeller said. "They settled because they were guilty and they knew it, and because they were going to be hit with a fraud charge from [New York attorney general] Andrew Cuomo."
"We did not commit fraud," UnitedHealth said in a statement. The company, which did not acknowledge any wrongdoing when it reached its settlement with Cuomo, said it had addressed concerns about the database's independence by agreeing to spin it off.
The settlement reached between the New York attorney general's office and UnitedHealth requires the health insurer to pay $50 million toward a new not-for-profit research entity that will provide patient data and help determine prices for out-of-network care. Another agreement between UnitedHealth and a group led by the American Medical Association will result in UnitedHealth paying a $350 million settlement for similar claims pertaining to reimbursement rates.
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