ACA Joins Class Action Lawsuit Against United Healthcare
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: