Calling testimony on the Ingenix out-of -network reimbursement database “profoundly troubling,” a Senate committee chairman called for more accountability by those responsible.

John "Jay" Rockefeller

Sen. John “Jay” Rockefeller (D-W. Va.), chairman of the Senate Commerce, Science and Transportation Committee, made his comments at the conclusion of a hearing today (March 31), after Andy Slavitt, the CEO of Ingenix, and Stephen Hemsley, the president and CEO of UnitedHealth Group, which owns Ingenix, testified on the performance of the database which has come under great scrutiny.

UnitedHealth Group reached a $50 million settlement with New York Attorney General Andrew Cuomo, whose office found fault with the technology and the insurer has also reached a $350 million settlement over out-of-network medical services regarding Ingenix with the American Medical Association.

In their testimony, both Slavitt and Hemsley defended the role of Ingenix as merely an aggregator and not the source of reimbursement rates for insurers. Both said they stand behind the integrity of the database. Both also said while Cuomo found a perceived conflict of interest with Ingenix as a subsidiary of UnitedHealth Group, which used its services to set reimbursement rates, no actual conflict existed.

“We would …like to make clear that there is an important difference between an inherent conflict and the actual practice of bias,” Slavitt said. “The latter is something neither I, nor my employee, nor our parent company would tolerate. We are hopeful that removal of concerns over these databases will prove a meaningful step forward in creating such a system.”

Painting a ‘rosy’ picture

Rockefeller and others on the committee were willing to agree that a change in ownership of the reimbursement database was beneficial, but grilled both CEOs on the past and Cuomo’s claims that hundreds of millions of customers were under-reimbursed.

To date, Cuomo has reached agreements with some of the nation’s largest insurers, including Aetna, CIGNA and WellPoint, to abandon the current database and pledge a collective $90 million for the new entity.

Rockefeller said the pair did “a heck of a job” painting the future as “so rosy,” but neither were willing to explain or take accountability for past trouble in light of millions in settlement dollars.

Sen. Claire McCaskill (D-Mo.) asked the pair why they did not do anything sooner, knowing there was something wrong with the database system, an admission essentially made through the two settlements.

Hemsley said that the settlement with the AMA was to resolve a decade-old issue and a move in “continuing a more constructive relationship with the health care community at large.”

McCaskill added that the way Ingenix was marketed to insurers was essentially to “get out of paying” the right reimbursement rate, a charge Slavitt outright denied.
“What our clients want to do is pay accurately,” he said. “The leaps you are making are not appropriate.”

The Missouri senator said neither Slavitt or Hemsley was willing to take ownership of the problem, yet “it is my understanding that cases get settled because you are afraid you’ll get nailed in court.”

“This is why there is such a lack of confidence in health care,” she said. “The way you did this, putting the wrong information, put consumers on the short end of the stick. I think this committee needs to stay on you like white on rice.”

Future steps

Rockefeller continued to push for accountability from both executives. He could not get either to justify the investigation by Cuomo’s office or acknowledge if there was “scrubbing” of data by insurers to skew reimbursement rates in their favor.

“I don’t know how you slept at night” in the years leading up to the settlements, Rockefeller said.

He added that with Hensley rated by Forbes as one of the top-earning CEOs in the nation and a reported $3 billion in profits by UnitedHealth Group last year, “$10 in doctors visits here and there probably doesn’t make you lose sleep, but it does” for the average American.

“This is profoundly troubling testimony from both of you,” he said.

Rockefeller said with Cuomo getting seven of the top 25 health insurers to commit to change regarding Ingenix, the Senate committee will be writing the rest to inquire about their plans on future use. He also plans a letter to the U.S. Office of Personnel Management to see if “hundreds of thousands of federal workers” were also under-reimbursed.

“American consumers deserve to know what they are getting …and this committee will be all about accountability,” he said. “I’m very unhappy …but I’m proud of you both coming here for taking what I see as very well-deserved abuse.”