This summer brought about insurer merger acquisitions of Cigna by Anthem and Humana by Aetna, which leaves UnitedHealth as the only remaining major insurer not to make such an announcement. However, the UnitedHealth Group Inc. very recent settlement of a suit over 15 years old and another settlement of a suit that was over 6 years ago is a typical business effort to clean up their books in preparation for a huge transaction of this sort. Here’s the backstory:
In May 2015, UnitedHealth Group agreed to pay $11.5 million to settle lawsuits brought by the state medical societies and individual doctors. The dispute arose over how UnitedHealth pays and codes claims. Specifically, the lawsuit claimed that UnitedHealth was systematically denying payments to doctors for medically necessary claims solely to meet internal financial goals. It was alleged that UnitedHealth programmed its software to automatically downcode claims and penalize doctors whose charges weren’t within a certain range of treatment costs. When the lawsuit was originally filed over fifteen years ago, it represented medical societies in 19 states. At the time of settlement, only four states remained and included Connecticut, New York, North Carolina, and Tennessee. As part of the settlement, UnitedHealth agreed to spend at least $9 million to enhance the insurer’s website where providers file claims. The settlement also required money to be paid by the insurer to the Connecticut State Medical Society Physician’s Health and Education Fund and will be spent on educational programs for members regarding: medical coding, medical review audits, appeals, submitting and processing electronic claims. Physician Advisory Councils will be created in Connecticut, New York and Tennessee that will help doctors and providers resolve issue or problems with UnitedHealth.