ConsumersbytheHealthInsuranceIndustryReport.pdfVIP

COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION OFFICE OF OVERSIGHT AND INVESTIGATIONS UNDERPAYMENTS TO CONSUMERS BY THE HEALTH INSURANCE INDUSTRY Staff Report for Chairman Rockefeller June 24, 2009 Table of Contents Executive Summaryi I. “Usual and Customary” Rates in the Health Insurance Industry1 a. The “Out-of-Network” Health Care Option1 b. The Development of “Usual and Customary” Reimbursement Rates2 c. Ingenix: the Only Commercial Source of Medical Claims Data3 II. Ingenix’s Close Ties with the Health Insurance Industry4 a. The Business Relationship Between Ingenix and Individual Health Insurance Companies4 b. Data Contribution Agreements Between Ingenix and Insurers6 c. How Ingenix Products Were Used to Determine Reimbursements7 d. Health Insurers Acknowledge the Conflict of Interest with Ingenix8 III. Challenges to the Reliability of the Ingenix Databases9 a. Private Legal Actions10 b. The New York Attorney General’s Investigation11 IV. The Senate Commerce Committee Investigation12 a. The Use of Ingenix Database Products Was Widespread13 b. The Deliberate Lack of Transparency in Disclosure Materials14 c. The Continuing False Attribution of Data to HIAA16 d. New Evidence of Ingenix Data “Scrubbing”17 e. Ingenix Was Used to Pay Federal Employees’ Claims and Military Family Claims18 f. Regulatory Mandates to Use Ingenix18 g. The Use of Ingenix Data by Self-Funding Insurers19 h. Ingenix Was Used in Other Health Insurance Products20 Executive Summary Since Chairman Rockefeller held two h