Missouri Department, UHC Reach Settlement

The Missouri Department of Insurance, Financial Institutions and Professional Registration has entered into a national settlement agreement with certain companies under United Healthcare over alleged violations of claims payments.

The settlement is part of an agreement between UHC and approximately 39 states in which the company conducted business. This action effectively brings an end to a lengthy investigation of the manner in which the companies processed certain claims for medical services that were performed and handled provider complaints and grievances.

The settlement states that the companies agree to pay a monetary settlement to the state of Missouri in the amount of $737,758.63. The amount will be forwarded to the Missouri State School Fund.

The investigation focused on the companies’ compliance with certain insurance and health maintenance organization laws of the various jurisdictions. The multistate areas of concern identified included claims handling and other insurance administrative practices and the compliance of those practices with the laws of the applicable jurisdictions. The lead regulators from the states of Arkansas, Connecticut, Iowa, Florida, and New York identified specific areas of concern that the companies have agreed to be subject to review on a collaborative basis for the benefit of the participating state regulators.

The UHC companies also agreed to make restitution to insureds and providers under certain circumstances. Additionally, through a company improvement plan, UHC has agreed to make restitution to policyholders and providers for claims that were identified as receiving less than appropriate payments. The review of these claims covers a period no more than thirty-six (36) months immediately prior to the effective date of this settlement.

Under the terms of the settlement, the companies agree to take steps to correct areas of concern specifically identified during the investigation. Quarterly third party reviews of UHC’s compliance with the improvement plan will be conducted and improvement in all areas is expected to be completed by the end of 2010.

In the event United Healthcare fails to meet the yearly process-improvement benchmarks outlined in the multistate agreement, an additional assessment of up to $20 million could be levied against the company. This agreement allows the department the flexibility to address future issues as they arise.