Private Plan Profiling, Reimbursement under Close Watch by AMA, New York Officials
Scrutiny of insurers’ physician profiling and reimbursement practices continues from both the medical and legal communities, with expansion of a New York attorney general investigation and a recent study by the AMA. Last week, Andrew Cuomo issued subpoenas to Aetna Inc., CIGNA, UnitedHealth Group and WellPoint, Inc., in a broadening investigation of possible fraud that includes the accuracy of reimbursements. Separately, a recent AMA study looked at the Wellmark Blue Cross and Blue Shield “incent and rewards” program and United Healthcare’s Premium Designation program. As part of the study, the AMA created charts that help physicians analyze and spot both problems and merits within each program. Learn more about physician profiling.
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