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UnitedHealth agrees to $11.5M settlement over claims payment

2001 lawsuit alleged insurer programmed its software to automatically downcode claims

UnitedHealth will pay $11.5 million as part of a settlement with state medical societies and individual doctors who sued the insurer 15 years ago over how much it pays and codes claims.

Connecticut, New York, North Carolina and Tennessee filed a lawsuit in 2001 claiming that UnitedHealth was systematically denying payment to doctors for medically necessary claims solely to meet internal financial goals, reported the Charlotte News & Observer.

The lawsuit said UnitedHealth programmed its software to automatically downcode claims and penalize doctors whose charges weren't within a certain range of treatment costs, causing lower provider reimbursements. Plus, the medical societies alleged that that UnitedHealth's third-party reviewers demanded refunds for "overpayments."

As part of the settlement, UnitedHealth has agreed to pay $9 million to boost its self-service website that doctors use to file claims. UnitedHealth said those enhancements are almost finished, the Hartford Courant reported.

Much of the remaining $2 million that UnitedHealth must pay will go toward the medical societies' education funds and create physician advisory councils, which will help doctors resolve any issues with the insurer.

"We are pleased to have resolved this nearly 15-year-old litigation," UnitedHealth Group spokesman Daryl Richard said in a statement, according to the Courant. "Physicians will have simpler and more comprehensive access to claims management information through enhancements we are making to our physician web site."

To learn more:
- read the Charlotte News & Observer article
- see the Hartford Courant article

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