Labor Department Sues UnitedHealth Group Over ‘Thousands’ of Claims Denials
By Admin | August 07, 2023
The Labor Department recently sued UnitedHealth Group subsidiary UMR, alleging that it wrongfully denied claims for emergency room services and urinary drug screenings since 2015. UMR did not determine the medical necessity of the claims, denying them “based solely on diagnosis codes and not applying a prudent layperson standard," according to the complaint.
The U.S. Department of Labor recently sued UnitedHealth Group subsidiary UMR, alleging that it wrongfully denied claims for emergency room services and urinary drug screenings since 2015.
The Labor Department’s complaint, which was filed Monday, charged that UMR denied claims “based solely on diagnosis codes and not applying a prudent layperson standard.” By doing so, UMR violated the Employee Retirement Income Security Act and Affordable Care Act, according to the lawsuit
UMR is a third-party administrator that provides benefits services for self-funded employer health plans. The Employee Retirement Income Security Act created claims adjudication standards for companies that administer employer health plans, requiring them to “act solely, exclusively and prudently in the interests of plan participants,” the complaint said...(More)
For more info please read, Labor Department Sues UnitedHealth Group Over ‘Thousands’ of Claims Denials, by MedCity News
