UnitedHealthcare Agrees to $20 Million Claims Settlement


The insurance giant UnitedHealthcare could pay up to $20 million to state regulators as part of an agreement to settle allegations that the company violated state laws in its claims processing.

Under the settlement, UnitedHealthcare has agreed to pay about $12.2 million up front to 36 states and the District of Columbia. The payout could grow to $20 million if other states join the suit.

UnitedHealthcare has also agreed to a 3-year process improvement plan. The company will be required to self-report data quarterly and annually on how it performs on a set of national performance standards. These benchmarks will focus on claims accuracy and timeliness, appeals review, and consumer complaint handling. A lack of compliance with the benchmarks could result in additional financial penalties, according to the National Association of Insurance Commissioners.

The settlement follows a multistate investigation that found errors in claims processing such as not applying correct fee schedules and deductibles. There were also frequent violations of prompt payment rules, according to the New York State Insurance Department, a lead party in the settlement.

The settlement was praised by the National Association of Insurance Commissioners and the states involved. UnitedHealthcare also praised the settlement as evidence of how the industry can work with state regulators. “This new, forward-thinking approach focuses the regulatory process for the states and our company on a practical set of uniform performance standards, while providing clearer and more meaningful means of assessing how well we are serving customers,” Kenneth A. Burdick, CEO of UnitedHealthcare, said in a statement.

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