September 4, 2014 — A long-awaited decision was issued by the U.S. District Court in the pending action against United Healthcare/OptumHealth, a case led by the American Chiropractic Association: The Court granted class standing, which not only allows plaintiffs who are not within United’s network of providers to seek relief on a class-wide basis, but also endorses the applicability of the Employee Retirement Income Security Act of 1974 regulations to UHC/Optum’s requests for repayment.
The decision is a landmark step toward the goal of achieving significant reform of UHC/Optum practices. Any out-of-network DCs who are currently subject to a repayment demand from United or Optum should contact the ACA concerning the impact of the decision.
The lawsuit was first filed on Jan. 24, 2011, by the ACA, who represented a nationwide class of healthcare providers who were subjected to improper audits and recoupment demands by UHC in a violation of ERISA. On April 22, 2011, ACA amended the original complaint alleging that United, through its chiropractic network, OptumHealth, adopted a series of internal policies and procedures intended to improperly deny benefits.
In April 2012, the ACA and co-plaintiffs successfully defeated United Healthcare and Optum’s motion to dismiss, which allowed the profession to pursue alleged ERISA violations. The decision by the U.S. District Court for the District of New Jersey upheld the viability of the plaintiffs’ central, underlying claims against United and its co-defendants, including the inappropriate recoupment of reimbursements previously paid to providers.
The defeat of the defendant’s motion to dismiss allowed plaintiffs to pursue injunctive relief for the inappropriate and abusive practices long fought by the chiropractic profession, which have restricted patient care and, the profession believes, harmed the careers of doctors of chiropractic.
In December 2014, a New Jersey federal judge ruled that a doctor of chiropractic may pursue his overpayment allegations against United Healthcare even though his patients are no longer insured by the company. The ruling says patients are still subject to the health insurer’s overpayment recoupment procedures.
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