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UnitedHealthcare and United Behavioral Health will pay $15.6 million over federal and state investigations into alleged reduced mental health reimbursement rates that resulted in overcharges, according to the Department of Labor.
An investigation by the DOL’s Employee Benefits Security Administration and the New York State Attorney General discovered that, going back to about 2013, United reduced reimbursement rates for out-of-network mental health services, thereby overcharging participants for those services, and flagged participants undergoing mental health treatments for a utilization review, according to the investigation. This allegedly resulted in many denials of payment for those services, the agency said.
WHAT’S THE IMPACT
This violates the Mental Health Parity and Addiction Equity Act of 2008, which prohibits Employee Retirement Income Security Act-covered health plans from imposing treatment limitations on mental health and substance use disorder benefits that are more restrictive than the treatment limitations they impose on medical and surgical benefits.
According to the DOL, many participants and beneficiaries apparently did not receive the mental health and substance use benefits to which they were entitled under their ERISA-covered health plans.
Investigators also found United failed to disclose sufficient information about these practices to plans and their participants and beneficiaries.
In the settlement, UnitedHealthcare agreed to cease the violations, improve its disclosures to plan participants and commit to future compliance. A call to UHC was not immediately returned.
Acting Assistant Secretary for Employee Benefits Security Ali Khawar said via statement that the law requires parity between mental health and substance use disorder benefits and medical benefits, and that the agency has created a self-compliance tool that plans and insurance companies can use to meet the law’s requirements.
EBSA’s New York regional office conducted the department’s investigation.
THE LARGER TREND
UnitedHealthcare has come under fire for some of its practices in recent months. In June, the American Hospital Association sent a letter to the health insurer urging it to rescind a policy that would allow it to retroactively reject emergency department claims.
Soon after the letter was made public, UnitedHealthcare backtracked on the policy temporarily, but said it may revisit the policy in the future, when the COVID-19 pandemic ended.
ON THE RECORD
“Protecting access to mental health and substance use disorder treatment is a priority for the Department of Labor and something I believe in strongly as a person in long-term recovery,” said U.S. Secretary of Labor Marty Walsh. “This settlement provides compensation for many people who were denied full benefits and equitable treatment. We appreciate (New York) Attorney General Letitia James and her office’s partnership in investigating, identifying and remedying these violations.”
“In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before,” said James. “United’s denial of these vital services was both unlawful and dangerous — putting millions in harm’s way during the darkest of times. There must be no barrier for New Yorkers seeking health care of any kind, and I will always fight to protect and expand it. I thank Secretary Walsh for his partnership on this important matter.”