U.S. Federal Court Orders Special Master and 10-Year Injunctions for UnitedHealthcare Affiliate That Breached Fiduciary Dutie...
November 04 2020 - 3:47PM
A federal judge has ordered court-appointed supervision and 10-year
injunctions for health insurance giant United Behavioral Health
(UBH), a subsidiary of UnitedHealth Group (NYSE: UNH). After its
employees complete court-ordered training on generally accepted
standards of behavioral health care, UBH will be required to
reprocess 67,000 mental health and substance use disorder treatment
claims that it illegally denied over a six-year period.
Psych-Appeal is co-counsel to the plaintiffs in this class action.
The November 3, 2020, remedies order is the latest development
in the landmark mental health class action, Wit v. UBH. Having
previously found that UBH breached its fiduciary duties to over
50,000 insureds by denying their mental health and substance use
claims based on pervasively flawed medical necessity criteria,
Chief Magistrate Judge Joseph C. Spero of the U.S. District Court
for the Northern District of California determined that, for a
10-year period, UBH must exclusively apply guidelines developed by
nonprofit clinical specialty associations.
“This order brings us one step closer to final relief for UBH
insureds subjected to years of systematic misconduct,” said Meiram
Bendat of Psych-Appeal and co-counsel for the plaintiffs, who
uncovered the UBH guideline flaws. “The federal court has sent a
clear message that when insurers promise to evaluate mental health
claims pursuant to generally accepted standards of care, they will
be held accountable to those standards. Profit motives will not be
allowed to infect the claims administration process.”
In 2008, Congress passed the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act. While the federal
law requires parity for mental health and substance use benefits,
it also allows insurers to evaluate claims for medical necessity.
However, by developing or purchasing their own medically necessary
criteria, insurers have been able to circumvent parity in favor of
financial considerations and prevent patients from receiving the
type and amount of care they actually require. Some states, like
California, have swiftly responded to the court’s findings in Wit
and recently enacted strict legislation to close this loophole.
Wit et al. v. United Behavioral Health and Alexander et al. v.
United Behavioral Health, were brought under the Employee
Retirement Income Security Act of 1974 (ERISA) in 2014, certified
in 2016 and tried in October 2017. On March 5, 2019, Judge Spero
ruled in favor of the plaintiffs, a watershed moment that is
changing the mental health parity landscape in the United
States.
The remedies ruling affects UBH insureds who were denied
outpatient, intensive outpatient and residential treatment from
2011 to 2017. Only ERISA participants and beneficiaries are class
members in this lawsuit. The statute does not allow plaintiffs to
collect punitive monetary awards. Non-ERISA insureds, such as
government employees, who were denied coverage under the same
flawed guidelines, are required to rely on regulators to hold UBH
accountable.
“The next step in mental health parity is now firmly in the
hands of state and federal governments,” said Bendat. “It is up to
our elected officials to enforce the parity laws that exist and
implement new measures, such as SB 855 recently passed in
California.”
Psych-Appeal and Zuckerman Spaeder were appointed class counsel
by the federal court and represent plaintiffs in several class
actions against other insurers.
About Psych-AppealPsych-Appeal is the first
private law firm in the United States exclusively dedicated to
mental health insurance advocacy on behalf of patients and
providers. The firm is recognized as a national leader in the area
of mental health parity, spearheading numerous high-profile cases
and collaborating with The Kennedy Forum and The Saks Institute for
Mental Health Law, Policy, and Ethics. For more information, visit
www.psych-appeal.com.
Contact: Chantal Allan
(310) 598-3690 x.201|callan@psych-appeal.com
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