AMA, others suing Aetna, Cigna over payments

INDIANAPOLIS — The American Medical Association is joining several state associations in suing health insurers Aetna Inc. and Cigna Corp. over a database they say was rigged to underpay doctors on out-of-network claims for more than a decade.

But Cigna says the rates doctors charge are part of the problem.

The lawsuits heap more criticism on Ingenix Inc. data that already has cost Minnetonka, Minn.-based UnitedHealth Group Inc. $350 million to settle a separate lawsuit involving the AMA.

Ingenix, a UnitedHealth subsidiary, also has drawn the ire of New York Attorney General Andrew Cuomo, who said last month poor reimbursement by insurers, thanks to Ingenix data, has led to higher medical bills for consumers.

The latest complaints accuse Hartford-based Aetna of deleting valid high charges from figures contributed to an Ingenix database. They also accuse Philadelphia-based Cigna of hiding "serious, systemic flaws" in the data.

Insurers use the data to determine "usual and customary rates" for care received outside their networks. But Aetna and Ingenix "cooked the books" and corrupted the database, according to a complaint filed Monday in U.S. District Court for the District of New Jersey. That led to skewed data, which lowered the reimbursement doctors received.

And that strained physician-patient relationships, the complaints states.

"We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without regard to patients, or the legitimate costs required to care for them," AMA President Dr. Nancy H. Nielsen said in a statement.

The associated cited, as an example, an unnamed doctor who performed a 2003 breast reconstruction surgery. It said Cigna paid him $10,000 — or $7,000 below his billed charges — due to its "usual and customary" rate calculation and the fact that multiple surgeries were performed.

Aetna spokeswoman Cynthia Michener said the lawsuits are similar to claims already filed by consumers in state courts in New Jersey and Connecticut.

"We intend to continue to defend the company," she said. "We're disappointed the medical community has chosen to litigate on top of already pending consumer litigation on the same topic."

She said the insurer has developed "much improved" relationships with doctors over the past several years and wants to continue "collaborative dialogue with them on this topic."