Dive Brief:
- UnitedHealthcare has agreed to pay $15.6 million in a settlement after Department of Labor investigators found the insurer reduced reimbursement rates for out-of-network mental health services and denied payment for some services.
- UnitedHealth also failed to disclose these practices to plans and beneficiaries. All of these actions, which date back to at least 2013, violate the Mental Health Parity and Addiction Equity Act of 2008, DOL said Thursday.
- The settlement includes $13.6 million to be paid to about 135,000 affected beneficiaries as well as nearly $2.1 million in penalties. UnitedHealth also agreed to improve its disclosure plan and commit to future compliance.
Dive Insight:
In a call with reporters Thursday, DOL officials said the agency is stepping up enforcement of the parity law, especially as the COVID-19 pandemic has caused a greater need in those services.
"There are really a number of people that really are looking at these issues in a different way," said Ali Kwahar, acting assistant secretary of labor for employee benefits. "And these efforts, our efforts today and our ongoing efforts to enforce parity really are part of a broader approach that we have that also includes making sure that we're raising awareness and reducing some of the stigma that exists around these conditions."
During the pandemic, four in 10 U.S. adults have reported symptoms of anxiety or depression, compared to one in 10 before the onset, according to the Kaiser Family Foundation.
Investigators found that UnitedHealth flagged mental health patients as needing additional review, resulting in the claims denials.
DOL officials pointed to changes from the Consolidated Appropriations Act that they said allow for greater enforcement of the parity act. For one, insurers are now required to perform a written analysis of the limitations they have on mental health coverage that aren't numerical, such as a restriction on the number of visits.
Those nonquantitative limitations can be harder for investigators to pursue, but are becoming a greater focus, Kwahar said.
"You should expect to see more investigation," he said. "We have taken a look at our existing inventory of cases and ... I predict this will be a very active issue for us for years to come."
In a statement, UnitedHealth Group said it is "pleased to resolve these issues related to business practices no longer used by the company."
