The settlement stems from violations of the Mental Health Parity and Addiction Equity Act of 2008.
United Behavioral Health and parent United Healthcare Insurance Co. will pay $15.6 million to settle allegations that the payer unlawfully denied mental health and addiction treatment services to thousands of people.
The settlement comes after a joint investigation by the U.S. Department of Labor's Employee Benefits Security Administration and the New York Attorney General's Office found that since 2013 United Behavioral had reduced reimbursements for out-of-network mental health services, which resulted in overcharges for about 20,000 plan enrollees in New York and other states.
"United's action violated 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," DOL said.
As a result of United's violations, beneficiaries did not get mental health and substance use benefits mandated by their ERISA-covered plans. More than $13 million of the settlement will be paid to those beneficiaries, with the remainder collected as penalties, DOL said.
United also failed to disclose adequate information about these practices to plans and their beneficiaries, and has agreed to stop the violations, improve its disclosures to plan participants and commit to compliance.
"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," New York Attorney General Letitia James said.
"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 healthcare of any kind, and I will always fight to protect and expand it."
UnitedHealth Group issued a statement saying it is "committed to ensuring all our members have access to care and to reimbursing providers consistent with the terms of the member's health plan and state and federal rules."
"We are pleased to resolve these issues related to business practices no longer used by the company. As part of our broader commitment to quality care, we continue to support our members with increased access to providers and new ways to get the effective behavioral support they need."
“United's denial of these vital services was both unlawful and dangerous – putting millions in harm's way during the darkest of times.”
New York Attorney General Letitia James
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
As a result of United's violations, beneficiaries did not get mental health and substance use benefits mandated by their ERISA-covered plans. More than $13 million of the settlement will be paid to those beneficiaries, with the remainder collected as penalties.
United also failed to disclose adequate information about these practices to plans and their beneficiaries, and has agreed to stop the violations, improve its disclosures to plan participants and commit to compliance.