UnitedHealthcare lawsuit: Physicians allege delay, deny, underpay practices
MINNETONKA, Minn. (FOX 9) - A federal lawsuit filed against UnitedHealthcare (UHC) by SpecialtyCare physicians alleges the company deliberately engages in the pattern of "deny, delay and underpay" which led to more than $900,000 in unpaid independent dispute resolution (IDR) awards.
Federal and state law violations
What we know: The lawsuit accuses Minnetonka-based UHC of using the Federal No Surprises Act (NSA) to "deny, delay, and underpay out-of-network providers."
SpecialtyCare, a company based out of Brentwood, Tennesse, filed the lawsuit on Dec. 11. The complaint states that after getting an IDR for out-of-network (OON) services, UHC deliberately delays payment far beyond the statutorily mandated 30-day deadline.
SpecialtyCare said providers must then navigate the NSA for a determination of fair compensation for medical services, which happens after they initially get low payments from UHC, or none at all.
By the numbers: From Oct. 26, 2022, to Dec. 1, 2024, UHC accumulated unpaid IDR awards that reached a total of $903,372 owed to SpecialtyCare, according to the lawsuit, which states, "UHC is ignoring federal law and violating state law and must be held accountable."
The lawsuit claims that even though UnitedHealthcare is aware of the requirement to pay IDR awards within 30 days, the company "does not invest in the compliance systems and personnel needed to meet its obligations under federal law because it knows that it, its shareholders, and the health plans it serves profit from lack of compliance and violation of the mandatory payment obligations."
FOX 9 reached out to UnitedHealthcare for a response and will update this story if one is received.
Killing of UnitedHealthcare CEO Brian Thompson
Big picture view: UnitedHealthcare CEO Brian Thompson was shot and killed in New York City the morning of Dec. 4 outside a Hilton Hotel before a UnitedHealthcare investor conference. Thompson, 50, lived in Maple Grove, Minnesota, with his wife and two sons.
While investigating the scene of the shooting, police found live rounds and ejected shell casings that had the words "deny", "depose", and "defend" written on them. The words on the ammunition may have been a reference to strategies insurance companies use to try to avoid paying claims, the Associated Press reported.
READ MORE: UnitedHealthcare CEO killing: Police say shell casings at scene match suspect's gun
The suspected shooter, Luigi Mangione, 26, was arrested at a McDonald's in Altoona, Pennsylvania., several days after the shooting. He was initially charged in Pennsylvania with an unlicensed firearm, forgery and providing false ID to police. Prosecutors in New York added a charge of murder. He's expected to be extradited to New York.
READ MORE: UnitedHealthcare CEO killing: Luigi Mangione charged with murder
Video shows him shouting to reporters as he entered court in Pennsylvania on Tuesday for an extradition hearing. Mangione appears to shout: "This is completely unjust and an insult to the intelligence of the American people. This is a lived experience."
The outburst came during the brief moments as he was pulled out of a squad vehicle and rushed into the courthouse.
UnitedHealth Group CEO message to staff
What they're saying: The UnitedHealth Group CEO Andrew Witty shared a message of support with UnitedHealth Group colleagues, referencing "an extraordinarily difficult week."
In that message, Witty said, "We owe it to Brian to make good on our promise to make health care work better for everybody, in every way. That job never stops. No matter what's happening, we're going to be there for the moms and dads who brought one of their kids to a clinic this morning".
He continued by reminding staff of the importance of their work, saying, "There is no higher calling than helping people. Nothing more vital to the human condition than health care."
Public reaction
Local Perspective: Public reaction to the arrest of the accused UnitedHealthcare CEO killer has been mixed, with many sympathizing with the suspect.
READ MORE: UnitedHealthcare CEO killer: Mixed response in MN to shooting
Much of the online discourse vents frustration at the United States health care system.
Police from multiple agencies surrounded UnitedHealthcare campus in Minnetonka, with a fence forming a security perimeter along with armored vehicles.
A police spokesperson told FOX 9 on Tuesday that there was no threat or incident that prompted their presence, but an event inside that they were supporting.