UnitedHealth pays denied insurance charges – Enterprise Insurance

(Reuters) – UnitedHealth Group Inc., the largest US health insurer, has settled federal and New York State charges that illegally denied coverage to thousands of patients with mental health problems and substance abuse.

The U.S. Department of Labor said Thursday that UnitedHealth will pay approximately $ 15.7 million, including $ 13.6 million in reimbursement and a $ 2.1 million fine to make a settlement with that agency and New York Attorney General Letitia James.

Authorities accused UnitedHealth of violating federal and state laws by imposing more restrictive limits on the coverage and treatment of mental illness and substance abuse disorders than it did on physical illness.

UnitedHealth has also been accused of overbilling patients for mental health services outside the network by cutting reimbursements.

Without acknowledging liability, UnitedHealth agreed to discontinue its use of algorithms, including in a program called ALERT, which required additional levels of verification before continuing mental health treatment and which often resulted in coverage being interrupted.

UnitedHealth, based in Minnetonka, Minnesota, said in a statement it was pleased to reach an agreement and is no longer using the contested practices, including ALERT.

It also said it was committed to providing care, including "behavioral support" and reimbursement to policyholders in line with federal and state regulations.

Ms. James said more than 20,000 New Yorkers will receive $ 9 million from the settlement and the state will receive $ 1.3 million in the fine.

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