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Connecticut State Medical Society Demands that United Healthcare/Ingenix Stop The Requests For Patient Records

Posted Feb 07 2010 8:20pm

Well if you are a physician in Connecticut and were not sure who and what Ingenix isyou are now if you received a multitude of requests for patient records.  Big question toowhy are the letters not going out under the United Healthcare letterhead and why Ingenix?  I might guess there’s a buck to be made here as that’s what Ingenix doesdata servicesbusiness intelligencealgorithms and studies that determine who gets paid and how much.  They made heaps and so did other insurance carriers until Andrew Cuomo went after them.  Everything is a buck and profit with this part of United Healthcare and their services are entwined in so many facets of healthcareand they say the fight fraud tooso which are they better atfighting it or creating it?  They also make a ton of money selling your medication records toothat come from pharmacy benefit managers and do not fall under the protection of HIPAA. 

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Before United gets the newly insured consumers perhaps they want the opportunity to “score” them first?  That’s what the algorithms of Ingenix and companies like them do best.  Nowon the other side of the coinany compensation for the time for the doctors to yet add one more administrative task to their already overloaded red tape bureaucracy of dealing with insurers?  Is the information on file with HealthNet not good enough?   Insurance carriers will jump through hoops and stand on their heads to get more data to analyze as the big move now is to further develop behavioral underwriting.

Red Brick is a client of Ingenix (a wholly owned subsidiary of United Healthcare) that specializes in datadatadata and more data along with analysis and recommendations.  Ingenix just settled a 9 year lawsuit with the AMA and there’s more suits in the works over the out of network compensation and probably more to come.  In reading the Aetna financial news they claimed that 20 million of their troubles were due to the fact that they are no longer using the Ingenix data base and that is why they took the 20m hit.  image

The article states that the the group of patients they were seeking records for were the Medicare Advantage consumers, the ones they make bigger profit margins from as all the insurers have been reporting in the news of latethe government subsidized Advantage plans have been the most profitable.  At any ratedoctors were urged to also make sure the requests were legitimate since they wheeled in on fax machines instead of a formalized letter in many cases.  United and Ingenix according to this article just blew off the Connecticut Medical Societywho also happens to be suing the state over the buy outhas not responded from their request.  BD  

Feb. 6--Doctors around the state have been receiving "potentially deceptive" requests for hundreds of patient medical records from a company affiliated with UnitedHealth Groupan insurer that has been given state permission to acquire another insurerHealthNet.

The Connecticut State Medical Societythe state's largest physician organizationannounced late Friday it has warned physicians about the requests and that it has "significant concerns regarding the legitimacy of the letters." It said that on Monday it demanded that UnitedHealth and HealthNet stop these reviews and requests immediatelyand that as of Friday afternoon had received no response.

Daryl Richardsspokesman for UnitedHealthsaid the requests were made by Ingenixa UnitedHealth subsidiary that provides health data review services to several insurers including both UnitedHealth and HealthNetin keeping with standard practices and patient privacy laws. The requests pertain to claims of patients with Medicare Advantageprivatized Medicare plans provided by insurance companies.

The reviews are being done to ensure that the claims are "complete and accurate," he said.

Audrey Honig Geragosianspokeswoman for the medical societysaid the society has received hundreds calls from doctors with concerns about the requests. Some received requests for records for up to 100 patients.

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