FAIR Health, Inc.: Tabulating Out-of-Network Usual & Customary Rates
In response to the Ingenix fall-out (where the Attorney General, Andrew Cuomo, led an investigation that uncovered fraudulent price-fixing for out-of-network reimbursement that resulted in a $400 million
settlement), $100 million was allocated to fund a new not-for-profit company to replace Ingenix as the company responsible for collecting pricing data and setting usual and customary rates for out-of-network providers. Cuomo announced on October 27, 2009 that FAIR Health, Inc., is that company. FAIR Health will be tasked with developing and maintaining an independent database for the establishment of usual and customary rates for out-of-network medical services. Once the information is collected by FAIR Health, the company is responsible for promulgating the information on the internet for easy access for consumers and out-of-network doctors. FAIR Health will be headquartered at Syracuse University and will consist of a research network from SUNY Buffalo, Cornell University, University of Rochester, and SUNY Upstate Medical University.
Cuomo's announcement fails to address the timeframe for FAIR Health development, where further financing will come from and whether legislation will be drafted requiring third party payors to abide by the usual and customary rates promulgated by FAIR Health. The brighter side of this announcement is that FAIR Health will hopefully move NY to a new level of transparency in price setting for non-participating providers.
I invite comments on this topic, but apologize in advance that this is all the information I have on FAIR Health at this time. Any additional information you may have and would be willing to share with the listserv is encouraged.
For additional information on this topic, please contact Jennifer Kirschenbaum at (516) 747-6700 ext. 308 or at Jennifer@Kirschenbaumesq.com. This email is for education and discussion purposes only and does not constitute legal advice. To access prior healthcare email newsletters or articles visit: www.kirschenbaumesq.com/healthcarearticles.htm.
