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Conflict of interest? Major report comparing McCain, Obama health plans authored by insurance company

Posted Nov 01 2008 7:50pm

The Lewin Group has released the most optimistic assessment to date of John McCain’s health insurance reform plan—without disclosing the firm’s acquisition last summer by the largest health insurance company in America, UnitedHealth. Ingenix, the UH subsidiary that now owns Lewin, has been condemned by a lead investigator at the New York Attorney General's office as "a conduit for rigged data."

Lewin is a leading source of independent, nonpartisan health policy analysis for the U.S. government.  Despite assurances given in June 2007, however, no corporate policy has been written to protect Lewin from interference by its parent companies.

October 27, 2008—A study comparing the Obama and McCain health insurance reform plans was released on October 8 by The Lewin Group, an influential health policy consulting firm and leading source of analysis for Congress and U.S. government agencies. The study rapidly became a mainstay of media campaign coverage, cited hundreds of times as a definitive source on the probable out-comes of each candidate’s plan.  

The Lewin Group makes most of its money consulting for government agencies on health care policy. Seeking lucrative managed health care contracts with some of the same agencies, Value Health sold Lewin in 1996 to avoid conflicts of interest.

A decade later, Ingenix did exactly the opposite, acquiring Lewin during a strategic push to win new government contracts.

Ingenix’s name, not Lewin’s, is embedded in the study's PDF metadata—a mistake at the printer's, say company officials. But they refuse to name the print shop in question.

The Lewin study offers the most optimistic assessment to date of  McCain’s proposal, estimating that it would result in health insurance coverage for an additional 21 million Americans (compared with 26.6 million under Obama’s plan) —more than twice the estimates of other independent analysts.  The study is cited on the McCain ’08 website and in campaign literature.

Undisclosed in the study was Lewin’s acquisition last June by Ingenix, a subsidiary of
UnitedHealth Group—America’s largest health insurance company.  UnitedHealth director Gail Wilensky is an unpaid McCain ’08 campaign health policy advisor.  UnitedHealth founder, Chairman Richard Burke, is a long-time McCain campaign contributor.

“It didn’t occur to us that we might have to address this,” said Lewin senior executive Vice President Lisa Chimento about the firm’s failure to disclose its ownership by UnitedHealth when it released the Obama/McCain study. “In hindsight, maybe we should have.”  

"We even mention Ingenix on our website," a Lewin Group official told epiNewswire.  But a search of the Lewin website yielded no mention of Ingenix.
She added, however, that such a disclosure in the report may have been interpreted as
evidence of inappropriate influence by Ingenix or UnitedHealth on Lewin.

Given recent controversy over Ingenix’s business practices, she may have a point.
Investigators at the New York Attorney General’s office believe Ingenix manipulated medical billing software to under-reimburse doctors, sticking patients with higher bills.  “Ingenix is nothing more than a conduit for rigged information," said chief investigator Linda Lacewell.  Ingenix officials hotly contest that assessment and emphasize the integrity of their employees and company.

“I don’t see why you don’t let this go,” said Lewin senior marketing manager Gregory Butera on Friday. “There's absolutely no subterfuge here. We even mention Ingenix on our website.”

A search of Lewin’s public website Friday afternoon found no mention of Ingenix.  Nor did the firm website’s archive of press releases for 2007 include any announcement of their acquisition by Ingenix.

Conflict of interest, or business plan?

Value Health owned Lewin in 1996, when they were competing for managed health care contracts at the Department of Defense (DoD) and other federal agencies. Lewin was consulting with several federal agencies on managed health and other health care policies, so in order to avoid any conflicts of interest, Value Health sold Lewin to another firm, Quintiles.

A decade later Ingenix did almost exactly the opposite—acquiring Lewin from Quintiles early in the company's strategic push to win government health care contracts. In 2006, without public fanfare, Ingenix launched a comprehensive 'public sectors initiative' to secure lucrative contracts with the DoD, U.S. Food and Drug Administration (FDA) and other government agencies.  By May 2007, Ingenix officials were finalizing negotiations for their acquisition of Lewin.

The acquisition raised some questions in the trade press about Lewin’s continued ability to consult for firms that compete with UnitedHealth and Ingenix. But similar questions were not raised regarding the firm’s consulting for the same government agencies from which Ingenix sought government contracts.  Most of Lewin's revenues come from government consulting.

Despite pledge, no firewall policy

When Ingenix purchased Lewin in June 2007, company officials pledged that Lewin would benefit from Ingenix’s data resources and “analytics and technologies.”  Because the details of  the acquisition were never made public, it is unclear exactly what that meant.

Less ambiguously, Ingenix also announced that Lewin’s editorial independence would be honored. But more than a year later, no formal “firewall” policy exists to protect the consultancy from interference by its new owners, Lewin officials confirmed.

“Nothing’s written—there are no legal documents,” said Chimento. “They did issue a press release when [Lewin was] purchased, that said we’d have editorial independence—and that has never been breached,” she said.

“That’s not good enough,” said Jim Balassone of the Markkula Center for Applied Ethics at Santa Clara University. An informal pledge that UnitedHealth and Ingenix will respect Lewin’s editorial independence “doesn’t measure up to industry ethical standards,” he said.  

Other independent health policy analysts expressed dismay that there is not a written policy protecting Lewin’s independence.  “That’s surprising, but there you go,” said one leading academic health policy analyst. “With all the controversy around Ingenix, who knows what to expect anymore.”

“When they say, ‘we have a firewall but it’s not written down,’ I become more suspicious,” said Balassone. “Good intentions are not enough. There must be formal policies—not just rumors of  policies—ensuring independence and transparency. Lewin should have a written and public policy related to this potential conflict of interest and include it in reports and publications.”

No formal firewall policies exist to protect Lewin's independence. Indeed, Ingenix is recruiting—and paying—analysts to work at Lewin.

“The ownership ought to be disclosed in every report and press release,” agreed Merrill Goozner, director of Integrity in Science, an industry watchdog group.  “They need internal controls and explicit, written policies.”

“The policy should include a help line for Lewin employees to report any pressure to ‘bend’ the policy,” Balassone added.

‘Autonomy is too strong a word’

Four months after acquiring Lewin, UnitedHealth was recruiting analysts familiar with the DoD and VA health systems to work at Lewin.

Chimento admitted that “autonomy is too strong a word” for Lewin’s relationship with Ingenix and UnitedHealth. “We are owned by them,” she said.

It is difficult to gage where the boundary exists between Lewin’s operations and those of Ingenix. UnitedHealth and Ingenix are recruiting and paying analysts who work at Lewin, confirmed Lewin senior marketing manager Gregory Butera on Friday.  UnitedHealth subsidiaries frequently integrate operations and share software and expertise. In Ingenix company literature Lewin is described not as an independently run company but as an Ingenix “market-facing brand.”

Lewin executives make all final hiring decisions, Butera and Chimento emphasized. But asked who pays the salaries of Lewin analysts, Butera said, “We’re all employees of UnitedHealth and Lewin.”  

Asked whether it would be accurate to state that UnitedHealth and Ingenix recruit and pay Lewin analysts, Butera said, “Yes.”

Butera and other Lewin officials insist that Ingenix and UnitedHealth were not involved in any aspect of the production or editing of the Obama/McCain study.  “They didn’t even see it until its release,” said Lewin spokeswoman Pat McMurray.  Chimento said Ingenix did receive a copy of the study before it was released but that “It wasn’t edited after that.”  

However, it is Ingenix’s name—not Lewin’s—that is embedded as metadata in the PDF version of the Obama/McCain study.  The document’s title field reads “Microsoft Word - 92035-ingenix-pcr-cx2.DOC.”

The PDF document’s author field reads “wmills.”  There is no Lewin employee named Mills, epiNewswire confirmed.

A day after repeated requests for an explanation for Ingenix’s name appearing in the study’s title field, Chimento said by email that Lewin’s study had been printed by an outside print shop that is an authorized Ingenix vendor.  She said that W. Mills is an employee at the print shop in question and that it was this individual who included “Ingenix” in the PDF’s title field, as part of a print work order code.     

Chimento did not respond to requests for the name of the print shop. Butera repeatedly refused to disclose the name or location of the print shop.

“I don’t think it’s necessary to name our vendor,” he said. “We’ve stated several times that there was no Ingenix involvement in the study.  There is no ethical issue here.”

Asked whether the print shop was in Falls Church, VA, where Lewin is based, or in Reston, VA, or Eden Prairie, MN, where Ingenix offices are located, Butera did not answer the question, saying instead only, “There is no W. Mills in Eden Prairie.”  

“They’re still obfuscating,” commented Balassone Friday evening. “There’s just not
transparency here.”

Asked Friday whether Lewin would now press Ingenix for a formal policy protecting its independence, Butera said, “I am not able to answer that.” 

Bryant Furlow covers the health care industry, public health policy, and international trade and security issues. He is contributing editor atepi Newswire and can be reached bryant  at epinews  dot com. 


Special Report: National Financial crisis threatens US health reformBryant Furlow in The Lancet Oncology, Published online October 22, 2008 

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