U.S. DOL Sues UnitedHealth Group over Improper Claims Denials

August 3, 2023

On Monday, July 31, 2023, the United States Department of Labor (DOL) initiated a lawsuit against UnitedHealth Group, alleging that the healthcare provider improperly denied thousands of patients' payments for emergency room services and urinary drug screenings.

The lawsuit, filed in the U.S. District Court for the Western District of Wisconsin, alleges that UMR, a third-party administrator and UnitedHealth subsidiary, failed to abide by requirements of the Affordable Care Act (ACA), Employee Retirement Income Security Act (ERISA), and the DOL's claims procedures regulation in the process of denying payments.

DOL alleges UMR denied all urinary drug screenings from August 2015 to August 2018, when it should have been reviewing each claim individually to determine if it was medically necessary or not. In August of 2018, UMR changed its urinary drug screening process because 98% of claims were overturned on appeal. Since August 2018, UMH is alleged to have approved payment for some drug screenings in emergency settings; however, its explanation of benefits was still not in line with ACA requirements.

The lawsuit also alleges that UMR does not inform claimants of the informal appeal process, and only limited information was given to those whose urinary drug screening payments were denied, with no reference to plan provisions or explanations of the denied claims.

Click here to read more on this story, and click here to access the lawsuit itself.

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