As previously reported in DOTmed News (DM 7958), the American Medical Association (AMA) had applauded New York State Attorney General's office investigation of the troubled Ingenix database. Now CIGNA has announced it has partnered with New York Attorney General Andrew M. Cuomo "to support the creation of an independent not-for-profit organization to administer a new database to determine reasonable and customary charges when people obtain covered care from doctors outside of CIGNA's network." CIGNA says it will contribute $10 million to the new not-for-profit.

The AMA also released a statement from Nancy Nielsen, M.D., AMA President, approving the CIGNA decision to drop the Ingenix database. Dr. Nielsen stated on the AMA website: "The American Medical Association commends CIGNA Corporation for committing ... to the groundbreaking insurer settlements arranged by New York Attorney General Andrew Cuomo. In the wake of these agreements, the AMA calls on all health insurers to reject the fatally flawed Ingenix database.

"The Ingenix database has corrupted the system for paying out-of-network medical bills, resulting in patients and physicians being cheated by health insurers. A lack of transparency, accuracy and integrity in the payment system has allowed insurers to place profits ahead of their promises to patients.
"Health insurers who truly recognize the importance of restoring their damaged relationships with patients and physicians should commit to the solution proposed by New York Attorney General Cuomo without delay.

"The attorney general's proposal would remove the grossly flawed Ingenix database from the control of health insurers and create a new database operated by a not-for-profit entity. An independent and transparent database will keep private interests from corrupting the data used to set reimbursement rates for out-of-network care.

"While the new, independent database is a major step forward in reforming the health insurance industry, serious damages resulting from CIGNA's prior use of the flawed Ingenix database still need to be addressed. The AMA intends to continue its role in a pending class-action to obtain relief for physicians who were seriously harmed by CIGNA through the insurer's long-term use of the flawed Ingenix database.

"All health insurers should act immediately to end improper business practices involving the rigged Ingenix database and work to restore fair reimbursements to patients and physicians," Nielsen said.

The class-action suit Dr. Nielsen mentions is filed in the United States District Court, District of New Jersey. The complaint asks the court, among other demands, to declare that "CIGNA has breached the terms of its members plans with regard to out-of-network benefits in its members' health plans, and to award damages to Plaintiffs and the Class for unpaid benefits in ERISA plans to Plaintiffs and the Class, as well as awarding declaratory relief with respect to CIGNA's violations of ERISA."

Sources: AMA, CIGNA, Corrected Complaint filed by the AMA.

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