Ingenix began as a health care information technology (IT) company. Relatively early on the scene, the company sought to develop IT programs and procedures that would help health care insurers incorporate new technologies. Ingenix believed that new technologies could streamline the delivery of health care and improve a company's ability to make coverage decisions based on real-world data. Ingenix led health care insurers and providers through the information revolution. Although the bulk of the company's programs provided the promised benefits, some did not.
History
In 1974, a group of physicians and health care professionals founded a company called Charter Med. Charter Med reorganized in 1977 as United HealthCare. Then, in 1998, United HealthCare reorganized as UnitedHealth Group, creating five independent subsidiaries, including Ingenix.
Ingenix
Ingenix's strategic mission was to use information technology to help health care companies transform their organizations in a way that improved health care. Ingenix sees information as at the core of managed health administration.
Ubiquitous
According to the Ingenix website, its evolving portfolio of IT products and services provides the promised benefits, pointing out that "there is an Ingenix product at work in nearly every U.S. health care organization . . . [giving] . . . Ingenix . . . an unparalleled ability to address the health care industry's unique information technology requirements."
Center of the Storm
In February of 2008, Ingenix and its parent company found themselves in the center of a storm. New York Attorney General Andrew M. Cuomo began investigating allegations that insurers were unfairly forcing consumers to pay too large a share of the cost of out-of-network health care. Cuomo based his allegation on the insurers' use of two corrupted Ingenix "Usual and Customary Charges" databases. First, the attorney general said, Ingenix relied on its subscribers for the data those same subscribers used to determine coverage levels. Second, Ingenix was a subsidiary of the nation's second largest health insurer (a direct conflict of interest) and third, Ingenix had provided an opportunity---and economic motivation---for subscribers to contaminate the data to ensure that they paid as little as possible for out-of-network services.
In January 2009, UnitedHealth Group agreed to shut down the two databases and to pay $50 million to help fund a new, transparent and independent, database for use in determining out-of-network reimbursement rates for millions of consumers throughout the United States.
Senate Investigation
In March 2009, Senator Jay Rockefeller's Committee on Commerce, Science and Transportation held two hearings to examine how health care companies used the Ingenix databases.
In late June 2009, the committee staff issued a report (see References) that said, "Committee staff have reviewed persuasive evidence that . . . . Some insurance companies improperly 'scrubbed' valid charges before submitting their data to Ingenix. Committee staff have uncovered new evidence that a major contributor . . . submitted its data in a manner that violated the Ingenix data submission guidelines and harmed consumers by skewing prevailing rates downwards."
Until the new nonprofit company comes online, health insurers and others will continue to use the two Ingenix databases.
Tags: health care, information technology, care companies, care insurers, Committee staff