UnitedHealth sued by Labor Dept.

NEW: A unit of?UnitedHealth Group improperly denied payment for emergency room visits and urine drug tests, the US Department of Labor alleged in a new lawsuit. It's an unusual move for the department. The suit alleges that UnitedHealth's UMR subsidiary violated the law governing self-funded health plans, known as ERISA. Those plans are exempt from state insurance regulation, and federal overseers rarely intervene against administrators like UMR. My story here:

Another one gets a lawsuit... After the state of California announced its lawsuit against Cigna Healthcare for batch-denying claims, the Labor Department came out with its own investigation into UnitedHealth Group. They allege the plan administrator improperly denied thousands of emergency department and drug screening claims without assessing their merit. They are asking that denied claims since 2015 be re-adjudicated. #AI and #dataanalytics are GOOD for Healthcare, in my opinion, but not when used to remove the human element of a claim and gain insight into the #patients journey. https://lnkd.in/gybeSCtT

Hey Y'all! UnitedHealth Group (UHG) is being sued by the Department of Labor. According to a FierceHealthcare.com report, the Department of Labor alleges that UHG, through its subsidiary UMR, denied thousands of patients' payments for emergency room services and urinary drug screenings. The lawsuit states that these actions violated the Affordable Care Act (ACA) and Labor Department’s claims procedures regulation. The implications of this case are significant: ?? It raises questions about claim denial processes, and how these practices can potentially deny patients necessary treatments. ?? It highlights the ongoing need for adherence to ACA requirements and the urgency of regulatory compliance in the healthcare sector. The outcome of this lawsuit may hold larger implications. It underscores the importance of transparency and standard adherence in claim approval processes, and it could potentially set a precedent for future cases. Feel free to share your thoughts, share/repost, or tag health care professionals who you think would benefit from seeing this. #Healthcare #MedicalClaims #RegulatoryCompliance #UnitedHealthLawsuit #medicalbilling #medicalcoding #healthcareconsulting #chcs https://lnkd.in/gCccTyhk

The U.S. Department of Labor has sued UnitedHealth Group for inappropriately denying emergency department claims since 2015, per Bloomberg. UnitedHealth has used its massive size to torment physician practices across the country. The Secretary of Labor is now calling out UHG on its monopolistic actions. "An investigation found that UMR denied payment for 'medically necessary claims,' Ruben Chapa, regional director for the Employee Benefits Security Administration in Chicago, said in an email. The department wants to ensure that 'participants in employee benefit plans receive the services that they have contracted for to meet their and their families’ medical needs.' Regarding emergency visits, UMR’s policies 'failed to consider what a person with average knowledge of health and medicine would think at the time the symptoms present themselves,' according to the Labor Department’s lawsuit. Instead, the company relied on the diagnosis after treatment 'to deny ER claims,' it said. The unit’s handling of claims violates the Employee Retirement Income Security Act, known as ERISA, which governs self-funded health plans, according to the suit. The department asked the court to order UMR to change its procedures for handling emergency visit and urine drug test claims, and re-adjudicate those denied since 2015." #emergencymedicine American College of Emergency Physicians American Academy of Emergency Medicine (AAEM) https://lnkd.in/gtrPpJSt

The U.S. Department of Labor has sued UnitedHealth Group for inappropriately denying emergency department claims since 2015, per Bloomberg. UnitedHealth has used its massive size to torment physician practices across the country. The Secretary of Labor is now calling out UHG on its monopolistic actions. "An investigation found that UMR denied payment for 'medically necessary claims,' Ruben Chapa, regional director for the Employee Benefits Security Administration in Chicago, said in an email. The department wants to ensure that 'participants in employee benefit plans receive the services that they have contracted for to meet their and their families’ medical needs.' Regarding emergency visits, UMR’s policies 'failed to consider what a person with average knowledge of health and medicine would think at the time the symptoms present themselves,' according to the Labor Department’s lawsuit. Instead, the company relied on the diagnosis after treatment 'to deny ER claims,' it said. The unit’s handling of claims violates the Employee Retirement Income Security Act, known as ERISA, which governs self-funded health plans, according to the suit. The department asked the court to order UMR to change its procedures for handling emergency visit and urine drug test claims, and re-adjudicate those denied since 2015." #emergencymedicine American College of Emergency Physicians American Academy of Emergency Medicine (AAEM) https://lnkd.in/gtrPpJSt