Health Care Fraud and Mismanagement

Attorneys general are known to bear unique responsibilities in the area of consumer protection. This includes the power to investigate and regulate health care institutions, including insurance companies and hospitals, in order to prevent fraudulent or unfair practices and promote the best interest of the consumer.

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Hospital Uninsured Patient Discount Act - Illinois

The Hospital Uninsured Patient Discount Act, drafted by Attorney General Lisa Madigan and passed by the Illinois legislature, provides for hospital charge discounts and caps on hospital bills for eligible uninsured patients.

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Blue Cross Blue Shield of Michigan

In 2008, Attorney General Mike Cox of Michigan opposed efforts by Blue Cross Blue Shield of Michigan (BCBSM) to pass legislation that he claims would "guarantee rate hikes on seniors and the seriously ill, eliminate financial oversight by the governor and attorney general, and allow BCBSM to purchase for-profit companies." Since then, Cox has vocally advocated for various reforms of BCBSM in order to maintain its status as insurer of last resort.

Cox also filed an unsuccessful lawsuit against BCBSM to force the insurer to apply funds that had been used to purchase a California worker's compensation fund instead toward reducing insurance costs.


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Fairness in coverage

Attorney General Richard Blumenthal of Connecticut Calls for Gender Equity in Health Care Coverage

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Health Care Reimbursement Litigation - New York

As part of New York Attorney General Andrew Cuomo's investigation of insurers' out-of-network reimbursement policy,  health insurance company Aetna settled with Cuomo for $5 million to reimburse college students who had been overcharged due to the use of outdated out-of-network coverage information. Cuomo had previously brought a similar suit against UnitedHealth and its subsidiary, Ingenix, for a similar case in which the insurer under-reimbursed members by using faulty out-of-network coverage data provided by Ingenix.

In February 2009, Cuomo announced plans to file suit against Univera Healthcare and its parent company, Excellus Health Plan, for underreimbursing patients due to flawed data from the Ingenix system. Cuomo also reached a settlement over reimbursements with Cigna Corp., which agreed to discontinue use of the Ingenix database.

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Allina Hospitals and Clinics - Minnesota

Minnesota Attorney General Lori Swanson filed suit in early 2009 against Allina Hospitals and Clinics for charging up to 18 percent interest on medical bills. According to Swanson, state law limits interest on medical debt at 8 percent.

Allina has agreed to reimburse any patients who were charged over 8 percent interest over the last two years, a settlement expected to be worth over $1 million.


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