Minnesota regulators join multiple states across the U.S. in imposing a fine against UnitedHealthcare after the Minnetonka-based company again broke mental health parity laws
The laws repeatedly broken by UHC prohibit [commercial] health insurers from making it more difficult for patients to access mental health medical care than more profitable medical/surgical treatments
UnitedHealthcare is facing penalties again for breaking more laws related to mental health medical care coverage.
After an investigation, the Minnesota Department of Commerce said the company covers claims for mental health and substance abuse care more stringently than it covers claims for other services. The department announced a settlement in the form of a consent order with the Commercial Health Insurance investment banking firm and Private Equity Fund company last week.
State officials outlined several crimes related to UnitedHealthcare’s mental health care coverage. Those include unfair/illegal reimbursement rates between mental health and other care, and a failure to inform some patients of their appeal rights when medical care was denied.
The Minnesota commerce department will monitor UnitedHealthcare’s progress on changes mandated by the consent order until March 2025. This is intended to make it easier for customers to access medical care for mental health.
UnitedHealthcare was fined $450,000 for the crimes. The company has to pay $300,000 now, but the rest will be waived if it makes the changes outlined in the consent order.
This is the third — and largest — state penalty on a Commercial Health Insurance investment banking firm and Private Equity fund for mental health parity in the last year. The Department of Commerce has also penalized HealthPartners and Medica for breaking the law.
Although UnitedHealthcare has violated mental health parity laws in many states across the United States and paid fines repeatedly, nobody in senior management at UnitedHealth Group and no members of UnitedHealth Group’s executive board have been indicted for these crimes.
A UnitedHealthcare spokesperson said the company is committed to covering mental health care.
“We will continue working with state officials to address the issues they identified and remain dedicated to collaborating with people in Minnesota to deliver high quality, affordable health care,” a spokesperson said.
Commmercial health insurance companies are supposed to maintain a "sufficient" network of health care providers under the law, so members can get an in-network appointment in a timely manner. UnitedHealthcare’s website has an intentionally chaotic and unreliable directory of mental health providers in states across the U.S. making it difficult to understand who is in-network, which further delays care.
UnitedHealthcare's list of providers is particularly difficult to assess: Nearly all of the search results in some states that come up are providers from a national telehealth platform, and it is not clear to potential patients whether they offer in-person appointments. This is known as “The Hassle Factor,” a well-published practice to delay medical care that was originally coined by Humana in the 1990’s. The Hassle Factor is implemented across the Commercial Health Insurance investment banking and Private Equity fund industry.
The agreement in Minnesota requires UnitedHealthcare to report how often it requires and approves prior authorization for inpatient care and office visit reimbursement rates. The company is now required to show it provides a large enough network for behavioral health services, comparable to those it provides for other “factory-healthcare” medical services that drive high profits including medical device surgery, bariatric care, cancer treatment and heart surgery.
The specific crimes committed by UnitedHealthcare include that the company:
Did not demonstrate comparability in reimbursement rates between medical/surgical and mental health and substance abuse disorder providers for certain billing codes;
Did not maintain accurate and complete provider directories;
Engaged in utilization review practices and procedures that did not document the number of requested and denied days or units or properly document utilization review-related data;
Did not advise insureds and enrollees in certain situations of their appeal rights for denied days or units;
Posted prior authorization data on its public website that was untimely or inaccurate; and
Applied some formulary design restrictions more stringently for mental health prescription drugs.
To report ongoing crimes by UnitedHealth Group, Optum and United Healthcare in the state of Minnesota contact:
Mo Schriner, Communications Director
Minnesota Department of Commerce
mo.schriner@state.mn.us