UnitedHealth Group Lawsuit Advances

Insurance Networking News, February 10, 2012

Joseph Goedert

In 2009, UnitedHealth Group agreed to settle for $350 million a lawsuit the American Medical Association filed charging the insurer with underpaying for out-of-network services. Now, a federal judge has issued rulings to release $200 million to settle claims that physicians filed against UnitedHealth.

In addition, $50 million of settlement money will go to patients and allied health professionals, and the rest to pay various fees. More than 600,000 claims were filed. More information on the forthcoming payments is available here.

The suit was one of at least four the AMA and several state medical societies have filed against insurers that used databases from UnitedHealth-owned Ingenix Inc., now called OptumInsight, to price out-of-network claims. Suits also were filed against Aetna, Cigna and WellPoint. The suits alleged that the insurers conspired for 15 years to underpay physicians for out-of-network services.

These insurers and several others operating in New York, were sued in 2008 or 2009 by the AMA and/or former New York Attorney General Andrew Cuomo, and later settled. According to Cuomo, claims were underpaid by up to 28 percent. Some settlements resulted in settling claims filed by physicians, patients and allied health professionals, but virtually all of the insurers also agreed to fund establishment of an independent database to price out-of-network claims.

For more information on related topics, visit the following channels:

• Claims
• Compliance