UnitedHealth Group Agrees to Pay $350 Million in Health Care “Fraud”

By Alexander Toldt
16:24, January 18th 2009
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UnitedHealth Group Agrees to Pay $350 Million in Health Care “Fraud”

UnitedHealth Group announced on Thursday its decision to pay a record $350 million to scammed customers in order to resolve the allegations it fixed a database which it used to establish rates for the patients who went for treatment to doctors outside the insurance company’s network.

The health care insurance company agreed to pay the money, but the deal did not include an admission of wrongdoing. The $350 million will go to fund a settlement with health plan members and providers.

UnitedHealth Group has a clientele of about 800,000 people in the Chicago area.

UnitedHealth Group’s agreement to pay for the affected customers comes just two days after the company agreed to pay $50 million in order to establish an independent pricing database.

Aetna, United States’ third-largest health insurance company, agreed to a similar deal. The company agreed to pay $20 million to the nonprofit body that would fairly determine rates for patients who use doctors outside the network.

Attorney General Andrew Cuomo, whose medical reimbursement plan seems to expand, said that they will not stop until the entire industry has been reformed.

"We are aggressively pursuing the other health insurance companies," Mr. Cuomo added.

At the heart of this scam is Ingenix, a subsidiary of UnitedHealth Group. Ingenix gave lower reimbursement figures than the patient had paid, which enabled insurance companies to lower payments to patients. Ingenix’s move was described as a “blatant” and “obvious fraud” by Mr. Cuomo.

The money which UnitedHealth Group and Aetna paid under the agreements will be used to set up a billing database free of conflicts of interest.



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