Medical Records Request Halted

UnitedHealth Group suspended patient chart review requests from its subsidiary Ingenix in the wake of an investigation by the Centers for Medicare and Medicaid Services, CMS.

While CMS has federal authority to require physician compliance patient record reviews, it said it didn't order the chart reviews. UnitedHealth Group, meanwhile, said it doesn't need CMS approval.

"The request was perfectly legitimate. But we had already temporarily suspended the chart review process before this to address physicians' concerns," said Daryl Richard, vice president for public relations, for UnitedHealth Group.

Physicians from Wilton to Wallingford complained that the requests from Ingenix, a subsidiary of UnitedHealth, weren't valid. That prompted the Connecticut State Medical Society to demand an investigation, said Audrey Honig Geragosian, director of communications for Connecticut State Medical Society.

The faxed requests cited a "Department of Public Welfare" that, according to CSMS, doesn't exist in Connecticut or at the federal level. The disputed letter also implied that CMS ordered the reviews. 

CSMS asked the state Department of Insurance, the Office of the Attorney General, and CMS to investigate. In addition, last Monday CSMS asked the Attorney General Blumenthal to investigate potential wire fraud and violations of fair business practices.

The problem was three-fold, said Dr. Claudia Gruss, a gastroenterologist with offices in Wilton, Norwalk, and Georgetown.

First, it was an onerous request. The fax asked each practice to submit between 75 and 100 records. Because most Connecticut practices have one or two secretaries, such a request unfairly burdens staff, Gruss said. Second, doctors weren't sure why they were being audited.  Third, they wondered whether the company, UnitedHealth, had a right to patient records, said Gruss, who is also president for Fairfield county Medical Association.

"Doctors have to be especially careful that the line between outside vendors, practices, and patients is carefully respected," Gruss said. "It wasn't clear if it United had a right to look at records when they were not actually buying the company [HealthNet]."

In December, UnitedHealth acquired HealthNet's Connecticut license and renewal rights, a transaction which CSMS has opposed in Superior Court. UnitedHealth said the record reviews were unrelated to its acquisition of HealthNet.