This is interesting as the law firm was one that worked on the Ingenix settlement a $350 million dollar settlement with United for misusing the Ingenix database to set "usual, customary and reasonable rates for payment. We all know the AMA just settled their portion an an overall class action suit.  It’s the algorithms and formulas once again as automation in some areas denies services with approval or denial when certain parameters of a claim is detected.  It’s the same process used to find fraud with queries; and the parameters get tweaked up and down depending on new laws, decisions and business intelligence analytics that advise and find such areas that can contribute to more profits.  United is one of the largest data sellers in healthcare and you can read below how they scored bit again. 

United Healthcare Buys Humedica and Gets More Data to Analyze and Sell To Medical Device and Drug Companies–More Big Profits From Health Data

In addition the AAFP recently confronted United for paying some doctors less than Medicare in the US, as again it’s complex calculated math models that create most of this anymore.  You can look at any time at job openings for United, and there’s always a ton of them out there all the time, quite a few areas are looking for quants.  BD

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job

At any rate you can look at the press release below with the details on the lawsuit.  BD

NEW YORK, March 12, 2013 (GLOBE NEWSWIRE) -- Pomerantz Grossman Hufford Dahlstrom & Gross LLP has filed a class action lawsuit against UnitedHealth Group Inc. ("UnitedHealth" or the "Company") (NYSE:UNH) and various subsidiaries, including United Behavioral Health. The class action was filed in the U.S. District Court, Southern District of New York, and docketed under 13 CV 1599, alleging violations of federal and state mental health parity laws and other related statutes. The action has been brought on behalf of three beneficiaries who are insured by health care plans issued or administered by United and whose coverage for mental health claims has been denied or curtailed. These plaintiffs seek to represent a nationwide class of similarly situated subscribers.

In addition, the action was filed on behalf of the New York State Psychiatric Association, Inc. ("NYSPA"), a division of the American Psychiatric Association, seeking injunctive relief in a representational capacity on behalf of its members and their patients.

Plaintiffs' counsels are continuing to investigate these claims and other related claims that may be added to the litigation. A copy of the Complaint can be obtained at To discuss this action, contact Robert S. Willoughby at or

888.476.6529 (or 888.4-POMLAW), toll free, x237. Those who inquire by e-mail are encouraged to include their mailing address, telephone number.

United is the country's largest health insurer, administrating plans on behalf of millions of consumers nationwide. As part of its health care plans, United administers mental health benefits, and is thereby subject to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the "Federal Parity Law"), as well as applicable state parity laws, including "Timothy's Law" in New York.

N.Y. Ins. Law Section 3221(l)(5)(A). In essence, these laws prohibit health plans from imposing limitations on mental health benefits that are more restrictive than those applied to traditional medical and surgical benefits.

Plaintiffs allege that United has adopted insidious, multi-layered policies and practices that violate applicable parity laws and impose unjustifiable restrictions on mental health care. Each of the three named individual plaintiffs has been subjected to and harmed by these policies.

Among United's most nefarious practices is its use of concurrent treatment reviews to prospectively limit and deny benefits for conditions that, by definition, are unpredictable. In doing so, United interferes with prescribed treatments and enforces policies contrary to generally accepted standards of care in the mental health community.

As detailed in the 100-page complaint, NYSPA has fielded numerous grievances from its members concerning United's systemic denials of mental health care. According to Seth P. Stein, NYSPA's Executive Director and General Counsel, "Over the past year, NYSPA has attempted to work with United Healthcare and its affiliates to resolve some of the issues identified in the complaint, but those efforts were unsuccessful." As Stein further explains, "Enforcement of existing state and federal parity statutes is paramount to ensure that individuals with mental illness receive access to necessary and appropriate care and treatment."

Problems experienced by NYSPA members and their patients in receiving proper mental health coverage have been widespread, with United curtailing psychotherapy for patients requiring long-term treatment, and allowing no more than weekly psychotherapy even for actively suicidal patients, including those who have been frequently hospitalized. NYSPA members have also reported that patients with United experience a great deal of difficulty obtaining initial and continued authorizations for intermediate levels of care, such as intensive outpatient treatment for mental health and substance use disorders.

"The mental health parity laws are designed to prevent the very practices in which United has engaged," says D. Brian Hufford, a Senior Partner of the Pomerantz firm and head of its health care practice.

"Through this action, we seek to compel United to change its restrictive approach to mental health care, while establishing uniform, industry-wide standards."

Adds co-counsel Meiram Bendat, "Safeguarding crucial access to mental health care is critical and a substantial factor in bringing this lawsuit."

The Pomerantz firm, with offices in New York, Chicago, San Diego and Florida, is acknowledged as one of the nation's premier plaintiff class action firms, and, in particular, has been an industry leader in health care class actions on behalf of providers and patients. In 2010, Pomerantz negotiated a $350 million dollar settlement with United for misusing the Ingenix database to set "usual, customary and reasonable"

("UCR") rates for out-of-network health services. Pomerantz was also appointed Chair of the Plaintiffs' Executive Committee in a multidistrict litigation pending against Aetna for similar practices. A

$120 million dollar settlement in that action has been submitted to the Court for preliminary approval. In designating Pomerantz as Chair, the Court highlighted Pomerantz's significant role in a $249 million settlement of its UCR class action against Health Net in 2008, stating the Court had "similarly appointed Pomerantz to be Plaintiffs` spokesman to the Court in the Health Net litigation because the Court found D. Brian Hufford, Esq. to be the attorney most capable of presenting Plaintiffs` position in a clear and concise manner." In re Aetna UCR Litig., 2009 Dist. LEXIS 66853, *8 n.4 (D.N.J. July 31, 2009). Recently, Mr. Hufford won an important victory before an en banc panel of the Fifth Circuit, which upheld a provider's misrepresentation and promissory estoppel claims against United. See Access Mediquip, L.L.C. v. UnitedHealthcare Ins. Co., 698 F.3d 229 (5th Cir. 2012) (en banc). Just two weeks ago, the U.S. Supreme Court denied United's writ of certiorari in the case, rendering the precedential Fifth Circuit decision final. See

Co-counsel Meiram Bendat is founder of the California-based mental health insurance advocacy service, Psych-Appeal. As a practicing psychotherapist and attorney, Mr. Bendat specializes in protecting the interests of patients impacted by mental health disorders and offers customized strategies for overcoming insurer denials of mental health treatment. Psych-Appeal is the nation's first and only private firm exclusively dedicated to providing this important service. See



Post a Comment

Google Analytics Alternative