UnitedHealth Group has reached a settlement agreement to pay a minimum of $20.25 million to resolve a lawsuit brought by the U.S.
The legal action, initiated in July 2023, stemmed from allegations that UMR, which manages health plans for large employers and organizations, failed to adhere to federal regulations requiring fair and timely processing of claims. Specifically, the Department of Labor claimed that UMR’s practices violated the Employee Retirement Income Security Act (ERISA), which sets standards for health and retirement plans to protect participants.
Under the terms of the settlement, UMR will be required to review and reprocess the denied claims, ensuring that affected healthcare providers are paid appropriately. Additionally, the company must implement corrective measures to prevent similar issues in the future, including enhanced training for staff and improved claims adjudication processes.
This settlement highlights the ongoing scrutiny of health insurance practices, particularly in relation to emergency services and diagnostic testing, which are critical components of patient care. It also underscores the importance of compliance with federal regulations designed to safeguard the rights of patients and healthcare providers. The resolution of this case is expected to bring relief to thousands of individuals and providers who were impacted by UMR’s alleged wrongful denials.
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