Suit says Indianapolis-based Wellpoint doctors underpaid

 

Friday, Mar 27,2009, 2:13:51 PM   Click:

Copyright: The Indianapolis Star
Source: Indianapolis Star, The
Wordcount: 416


Mar. 26 - Indianapolis-insurance giant Wellpoint - already under pressure to talk about health care reform heats up in Washington - has been named in a class action lawsuit accusing the company and its peers to defraud patients and doctors .

Wellpoint, which has 35 million members nationally, on Wednesday became the latest insurer to be sued over allegations that insurance companies took part in an industry-wide to underpay physicians for network medical services.

According to the prosecution, the practice has resulted in patients having to pay more of their medical expenses. The lawsuit was filed in federal court in Los Angeles on Wednesday by the American Medical Association and other plaintiffs, including several state medical societies.

Aetna Health and Cigna are facing similar class-action suits. The suits claim that the insurers conspired with database services Ingenix, owned by insurer UnitedHealth Group, to low reimbursement rates for out-of-network care.

The dispute, pitting one part of the health insurance largest industry players against the nation's largest organization of doctors, potentially at a delicate time for health insurers because they may be great changes in repayment of President Barack Obama to push health care reform.

Wellpoint shares forced doctors to spend significant time and resources to identify, in the case and then appeal the Wellpoint bad decisions on repayment, which often remains inadequate, "according to the lawsuit.


Wellpoint's Anthem Blue Cross and Blue Shield in Indiana Ingenix unit does not use to off-network pricing.

The prosecution alleges that Wellpoint has failed to disclose defects with Ingenix, including the database on average costs of physicians and health care providers who are not doctors.

In a statement by e-mail, Wellpoint Kristin Binns, spokesman said: "Wellpoint is committed to providing appropriate reimbursement for off-grid services. We are currently reviewing the complaint and are unable to d other comments at this time. "

In February, Wellpoint agreed to pay $ 10 million to settle a probe by New York Attorney General Andrew Cuomo in claims that it and other insurers Ingenix used to defraud consumers.

"Wellpoint recognize conflicts of interest in the Ingenix database," Ken Goulet, CEO of Wellpoint's Commercial Business, said in a press release announcing the settlement.

UnitedHealth agreed in January to close the database. A new database is being developed under the supervision of the Attorney General of New York office.

A committee of U.S. Senate plans to investigate allegations of insurer pricing from now on. AMA President Nancy Nielsen is scheduled to testify, said a spokesman for the AMA.

The Los Angeles Times contributed to this report.