A federal judge ruled UnitedHealth Group's behavioral health subsidiary must overhaul its claims processing following a lawsuit over thousands of denied claims.
Chief Magistrate Joseph Spero said the case represents "pervasive and long-standing violations" of the Employee Retirement Income Security Act by United Behavioral Health, with the company denying thousands of claims of behavioral health and substance abuse care to "protect its bottom line."
"To conceal its misconduct, UBH lied to state regulators and UBH executives with responsibility for drafting and implementing the guidelines deliberately attempted to mislead the Court at trial in this matter," Spero wrote.
As a result of the order, United Behavioral Health must reprocess all of the claims in question in the lawsuit, reform its protocols for processing claims and improve its employee education processes.
The court will appoint a special master to monitor UBH's compliance with the orders.
The case was first filed in 2014, and Spero initially ruled against United Behavioral Health in March 2019. Experts said it could be a landmark case in the push for greater parity in mental health coverage.
The lawsuit included more than 50,000 plaintiffs and represented tens of thousands of behavioral health claims.
"Today's ruling imposes as strong a remedy against UBH as the law allows and delivers everything the plaintiffs asked for," said Caroline Reynolds, a partner at Zuckerman Spaeder who led the case through trial and the remedy phase, in a statement. "The class members will get the relief they deserve and United has been forced to change its dangerous and self-serving behavioral health practices."
"This relief can't undo the pain United inflicted on thousands of adolescents and adults, but it will give them meaningful help and offer new hope for all who suffer from mental illness or addiction," she said. "This case should serve as a strong warning to all insurers that the courts are recognizing their discriminatory schemes and it's time to clean up their act."
We've reached out to UnitedHealth Group and will update when we hear back.