Ingenix Followup

[Preceding Commercial: don't miss a full day of coding and practice management education on this Friday, March 25, 2011 in Miami!]

Almost two years ago, I had my second blog piece about UHC, Ingenix, and what I felt (and was later confirmed to be) was their bogus fee schedule data.  Turns out that they ripped off physicians to the tune of 100s of millions of dollars.  Shocking, I know.

The issue came up on SOAPM this week and I relayed my previous experiences with the Ingenix data.  I received a very interesting reply from Dr. Stuart Cohen, a friend from way back.  He agreed to allow me post his response:


I was recently appointed to the first ever INGENIX physician advisory Board, tasked With being an oversight and audit body to monitor corporate integrity of the companies lines of business (compliance, hit, health care delivery consulting, etc...).This was one result Of the dissolution of their UCR determination business and fines paid after an AMA led lawsuit and subsequent investigation by the them New York state AG into improper practices By INGENIX's parent company, UHC. We actually do audit financials AND corporate integrity policies, such As how data can be used, shared, and/or disseminated, etc...

To the best of my knowledge, INGENIX statisticians and actuarial types assembled a large national UCR database and using accepted professional standards,(dropping outliers at both ends of the spectrum)to come up with a usable Database for their clients, including their parent company UHC. What allegedly happened is that UHC apparently manipulated the data and severely skewed the data to artificially lower UCR rates by as much as 40% over a long period of time. Some other insurers followed suit and also manipulated the INGENIX data. This aspect of INGENIX was dropped, and a new public and transparent company at Syracuse University, FAIR health, has Begun operating in their place. INGENIX continues their other lines of business, sending 1.5 billion dollars of revenue To the parent UHC last year. There is no involvement by UHC in the internal operations of INGENIX other than the INGENIX CEO Reports to the UHC Board.

What speaks well of the INGENIX employees is that 80% plus of the new FAIR company employees are the same statisticians And actuarials hired from INGENIX. The litigation center at AMA is monitoring the new company-we shall see in the comin g months how and or if the UCR database has improved rates for providers.

Stu Cohen MD, MPH
San Diego,Ca

Although I still have some giant questions about this arrangement - let's see the transparency about this "large national UCR database;" is the AMA the appropriate ethical steward of Ingenix, given the AMA's direct interest in maintaining their CPT copyrights? - I applaud Dr. Cohen for stepping into this role on behalf of physicians everywhere and for providing me with this update.  I've known Dr. Cohen for a long time and he brings to the table a strong cynical review of data being presented to him.  I hope he has more updates for us in the future.

In the meantime, he's happy to take questions, so ask away below if you're interested.