Medical News & Exposé
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The Lewin Group has released the most optimistic assessment to date of John McCain’s health
insurance reform plan—without disclosing the firm’s acquisition last summer by the largest health
insurance company in America, UnitedHealth. A McCain campaign advisor sits on the
UnitedHealth board of directors. Ingenix, the UnitedHealth subsidiary that now owns Lewin, is
under investigation for manipulating billing data and has been described by an investigator at the
New York Attorney General's office as "a conduit for rigged data."
Lewin is a leading source of independent, nonpartisan health policy analysis for the U.S. govern-
ment. Despite assurances given by Ingenix in June 2007, however, no corporate policy has
been written to protect Lewin from interference by its parent
companies. A senior Lewin official admits that “autonomy is
too strong a word” to describe the firm's situation, though she
is quick to deny editorial interference.
by Bryant Furlow
October 27, 2008—A study comparing the Obama and McCain
health insurance reform plans was released on October 8 by The
Lewin Group, an influential health policy consulting firm and leading
source of analysis for Congress and U.S. government agencies.
The study rapidly became a mainstay of media campaign coverage,
cited hundreds of times as a definitive source on the probable out-
comes of each candidate’s plan.
The Lewin study offers the most optimistic assessment to date of
McCain’s proposal, estimating that it would result in health insurance
coverage for an additional 21 million Americans (compared with 26.6 million under Obama’s plan)
—more than twice the estimates of other independent analysts. The study is cited on the
McCain ’08 website and in campaign literature.
Undisclosed in the study was Lewin’s acquisition last June by Ingenix, a subsidiary of
UnitedHealth Group—America’s largest health insurance company. UnitedHealth director Gail
Wilensky is an unpaid McCain ’08 campaign health policy advisor. UnitedHealth founder,
Chairman Richard Burke, is a long-time McCain campaign contributor.
“It didn’t occur to us that we might have to address this,” said Lewin senior executive Vice
President Lisa Chimento about the firm’s failure to disclose its ownership by UnitedHealth when it
released the Obama/McCain study. “In hindsight, maybe we should have.”
She added, however, that such a disclosure in the report may have been interpreted as
evidence of inappropriate influence by Ingenix or UnitedHealth on Lewin.
Given recent controversy over Ingenix’s business practices, she may have a point.
Investigators at the New York Attorney General’s office believe Ingenix manipulated medical
billing software to under-reimburse doctors, sticking patients with higher bills. “Ingenix is nothing
more than a conduit for rigged information," said chief investigator Linda Lacewell. Ingenix
officials hotly contest that assessment and emphasize the integrity of their employees and
company.
“I don’t see why you don’t let this go,” said Lewin senior marketing manager Gregory Butera on
Friday. “There's absolutely no subterfuge here. We even mention Ingenix on our website.”
A search of Lewin’s public website Friday afternoon found no mention of Ingenix. Nor did the
firm website’s archive of press releases for 2007 include any announcement of their acquisition
by Ingenix.
Conflict of interest, or business plan?
Value Health owned Lewin in 1996, when they were competing for managed health care
contracts at the Department of Defense (DoD) and other federal agencies. Lewin was consulting
with several federal agencies on managed health and other health care policies, so in order to
avoid any conflicts of interest, Value Health sold Lewin to another firm, Quintiles.
A decade later Ingenix did almost exactly the opposite—acquiring Lewin from Quintiles as part of
the company's strategic push to win government health care contracts. In 2006, without public
fanfare, Ingenix launched a comprehensive 'public sectors initiative' to secure lucrative contracts
with the DoD, U.S. Food and Drug Administration (FDA) and other government agencies. A new
subsidiary was created: Ingenix Public Sector Solutions. By May 2007, Ingenix officials were
finalizing negotiations for that new subsidiary's acquisition of Lewin.
The acquisition raised some questions in the trade press about Lewin’s continued ability to
consult for firms that compete with UnitedHealth and Ingenix. But similar questions were not
raised regarding the firm’s consulting for the same government agencies from which Ingenix
sought government contracts. Most of Lewin's revenues come from government consulting.
Despite pledge, no firewall policy
When Ingenix purchased Lewin in June 2007, company officials pledged that Lewin would
benefit from Ingenix’s data resources and “analytics and technologies.” Because the details of
the acquisition were never made public, it is unclear exactly what that meant.
Less ambiguously, Ingenix also announced that Lewin’s editorial independence would be
honored. But more than a year later, no formal “firewall” policy exists to protect the consultancy
from interference by its new owners, Lewin officials confirmed.
“Nothing’s written—there are no legal documents,” said Chimento. “They did issue a press
release when [Lewin was] purchased, that said we’d have editorial independence—and that has
never been breached,” she said.
“That’s not good enough,” said Jim Balassone of the Markkula Center for Applied Ethics at
Santa Clara University. An informal pledge that UnitedHealth and Ingenix will respect Lewin’s
editorial independence “doesn’t measure up to industry ethical standards,” he said.
Other independent health policy analysts expressed dismay that there is not a written policy
protecting Lewin’s independence. “That’s surprising, but there you go,” said one leading
academic health policy analyst. “With all the controversy around Ingenix, who knows what to
expect anymore.”
“When they say, ‘we have a firewall but it’s not written down,’ I become more suspicious,” said
Balassone. “Good intentions are not enough. There must be formal policies—not just rumors of
policies—ensuring independence and transparency. Lewin should have a written and public
policy related to this potential conflict of interest and include it in reports and publications.”
“The ownership ought to be disclosed in every report and press release,” agreed Merrill
Goozner, director of Integrity in Science, an industry watchdog group. “They need internal
controls and explicit, written policies.”
“The policy should include a help line for Lewin employees to report any pressure to ‘bend’ the
policy,” Balassone added.
‘Autonomy is too strong a word’
Four months after acquiring Lewin, UnitedHealth was recruiting analysts familiar with the DoD
and VA health systems to work at Lewin.
Chimento admitted that “autonomy is too strong a word” for Lewin’s relationship with Ingenix and
UnitedHealth. “We are owned by them,” she said.
It is difficult to gage where the boundary exists between Lewin’s operations and those of Ingenix.
UnitedHealth and Ingenix are recruiting and paying analysts who work at Lewin, confirmed Lewin
senior marketing manager Gregory Butera on Friday. UnitedHealth subsidiaries frequently
integrate operations and share software and expertise. In Ingenix company literature Lewin is
described not as an independently run company but as an Ingenix “market-facing brand.”
Lewin executives make all final hiring decisions, Butera and Chimento emphasized. But asked
who pays the salaries of Lewin analysts, Butera said, “We’re all employees of UnitedHealth and
Lewin.”
Asked whether it would be accurate to state that UnitedHealth and Ingenix recruit and pay Lewin
analysts, Butera said, “Yes.”
Butera and other Lewin officials insist that Ingenix and UnitedHealth were not involved in any
aspect of the production or editing of the Obama/McCain study. “They didn’t even see it until its
release,” said Lewin spokeswoman Pat McMurray. Chimento said Ingenix did receive a copy of
the study before it was released but that “It wasn’t edited after that.”
However, it is Ingenix’s name—not Lewin’s—that is embedded as metadata in the PDF version
of the Obama/McCain study. The document’s title field reads “Microsoft Word - 92035-ingenix-
pcr-cx2.DOC.”
The PDF document’s author field reads “wmills.” There is no Lewin employee named Mills,
epiNewswire confirmed.
A day after repeated requests for an explanation for Ingenix’s name appearing in the study’s
title field, Chimento said by email that Lewin’s study had been printed by an outside print
shop that is an authorized Ingenix vendor. She said that W. Mills is an employee at the print
shop in question and that it was this individual who included “Ingenix” in the PDF’s title field,
as part of a print work order code.
Chimento did not respond to requests for the name of the print shop. Butera repeatedly refused
to disclose the name or location of the print shop.
“I don’t think it’s necessary to name our vendor,” he said. “We’ve stated several times that there
was no Ingenix involvement in the study. There is no ethical issue here.”
Asked whether the print shop was in Falls Church, VA, where Lewin is based, or in Reston, VA,
or Eden Prairie, MN, where Ingenix offices are located, Butera did not answer the question,
saying instead only, “There is no W. Mills in Eden Prairie.”
“They’re still obfuscating,” commented Balassone Friday evening. “There’s just not
transparency here.”
Asked Friday whether Lewin would now press Ingenix for a formal policy protecting its
independence, Butera said, “I am not able to answer that.”
Firm authoring key study of Obama, McCain health insurance reform
plans failed to disclose ownership by America's largest health insurance
company
McCain campaign advisor is director at parent company UnitedHealth
Whether Obama or McCain wins,
plans for health reform take a hit,
reports epi's Bryant Furlow in The
Lancet Oncology
"We even mention Ingenix on our website," a Lewin Group official told
epiNewswire. But a search of the Lewin website yielded no mention of Ingenix.
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Ingenix’s name, not Lewin’s, is embedded in they study's PDF
metadata—a mistake at the printer's, say company officials.
But they refuse to name the print shop in question.
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No formal firewall policies exist to protect Lewin's independence.
Indeed, Ingenix is recruiting—and paying—analysts to work at Lewin
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The Lewin Group makes most of its money
consulting for government agencies on health
care policy. So when Value Health, a previous
owner, sought lucrative health care contracts with
federal agencies in 1996, it sold Lewin to avoid
any conflicts of interest.
A decade later, Ingenix did exactly the opposite,
acquiring Lewin during its strategic initiative to win
new government contracts.
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