United Behavioral Health and United Healthcare Insurance Co. will pay $13.6 million to affected participants and beneficiaries; pay $2,084,249 in penalties; and take other corrective actions following investigations and litigation by the US Department of Labor and the New York State Attorney General. An investigation by the department’s Employee Benefits Security Administration found that — going back to at least 2013 — United reduced reimbursement rates for out-of-network mental health services, thereby overcharging participants for those services, and flagged participants undergoing mental health treatments for a utilization review, resulting in many denials of payment for those services. United’s action violated the Mental Health Parity and Addiction Equity Act of 2008, which prohibits Employee Retirement Income Security Act-covered health plans from imposing treatment limitations on mental health and substance use disorder benefits that are more restrictive than the treatment limitations they impose on medical and surgical benefits. Many participants and beneficiaries did not receive the mental health and substance use benefits to which they were entitled under their ERISA-covered health plans due to United’s violations. Investigators also found United failed to disclose sufficient information about these practices to plans and their participants and beneficiaries. In the settlement, United agrees to cease the violations, improve its disclosures to plan participants and commit to future compliance.
