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ACA Joins Class Action Lawsuit Against United Healthcare

ACA Joins Class Action Lawsuit Against United Healthcare

The Chiro.Org Blog


ACA Joins Class Action Lawsuit Against UnitedHealthcare: Optum Included as Defendant and Additional Concerns Added to Complaint


On April 22, 2011, ACA joined an existing national class action lawsuit against United Healthcare (United) and HealthNet. The original complaint was filed on Jan. 24 by Pomerantz, Haudek, Grossman, and Gross (Pomerantz) on behalf of a class of individual providers and the Ohio State Chiropractic Association (OSCA). In February, the Congress of Chiropractic State Associations (COCSA) joined the litigation challenging United’s recoupment practices. In joining the lawsuit, ACA amended the complaint to include internal policies and procedures used by United and their chiropractic network, Optum, to improperly deny chiropractic benefits.

Pomerantz is a national class action law firm and is a leader in working with provider groups to combat insurance industry abuses, having filed two other similar class action suits in the last two years that involved doctors of chiropractic. In filing the amended complaint on behalf of ACA, Pomerantz added Optum to the list of defendants and also specifically outlined a number of policies and procedures allegedly utilized by Optum when managing the chiropractic benefit for enrollees.

Those allegations include (but are not limited to):

  • Not affording the patient appropriate appeal rights when the care authorized by Optum differs from the provider’s recommended care plan – an alleged violation of ERISA.
  • Optum refused to allow providers to request a specific number of visits or to submit clinical information necessary for appropriate utilization review in a deliberate attempt to avoid obligations under ERISA.
  • Optum subjected providers to threatening communications in order to pressure them to lower utilization rates.
  • Relying on statistically invalid data to determine average utilization rates and pressuring providers to reduce their utilization in order to lower the “community standards” and benchmarks against which providers’ profiles are compared.

These allegations are in addition to the original complaint alleging that United and HealthNet subjected providers to improper payment demands to return previously paid benefits by performing post payment audits to make retroactive adverse benefit determinations. In many cases, United and HealthNet withheld payment from new claims payments for unrelated services to recoup the money in a practice referred to as “offsetting.”

Additional details about the lawsuit can be found in ACA’s press release. You can also read the actual amended complaint. Providers who believe that they and/or their patients have been affected by United or Optum’s unfair practices may visit the Chiropractic Networks Action Center (CNAC) where they will find instructions and forms that can be used to submit a complaint to ACA. CNAC may be accessed by going to:
http://www.acatoday.org/CNAC

6 comments to ACA Joins Class Action Lawsuit Against United Healthcare

  • I say ‘stick it to the man.’ It’s insane that the CEO of United is making 55 million a year. What can he possibly do to deserve that much compensation?

  • Sharon

    I am trying to deal with UHC at this moment. They cancelled my long-term disability, because my one of my doctor’s said I had a good day.

    They also paid out claims under a different option leaving me responsible for 10% of my hospital stay which was covered under the option I purchased.

    Any suggestions?

  • Debbie

    This company is by far one of the worst in existence. They are becoming rich on the backs of the patients and the providers who try to give decent care. In my state, if I were the Governor, I would ban them from doing business. If we were all aware of how they operate, the entire country would (and should) ban them from conducting business. They routinely do things illegally to make mooney. They are the worst of the worst. I work writing letters of appeal to them to get payment for services that they deny illegally and inappropriately. Even if one of their members is seriously ill in the ICU, they deny care to that member. They are truly a disgrace and I have trouble understanding how they sleep at night. If you are reading this and work for United Health, please don’t bother to respond to my post because in my book anything you say is a lie as an employee there. Thank you!

  • How to I get in on this class action lawsuit? I am a provider of acupuncture services that is not getting paid and am getting the run a round. Appeals don’t work. Some of the practices/allegations stated in the lawsuit are what I have experienced.

    • Hi Nancy

      The same way we did, through a National Association and their legal team. The first issue is always what a given policy will cover. If the policy guarantees acupuncture coverage and they don’t pay, then you have a valid gripe.

      • Thanks…I will explore that path. Yes I have a contract with said insurer and they are suppose to pay for this service. I SPOKE with Optum health higher up today and I am hoping he can resolve or tell me why my provider service discount equals the amount I charged. In other words I work for free apparently. I have never seen such a crazy provider eob. Thanks

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