Dive Brief:
- UnitedHealthcare will pay $11.5 million to resolve allegations that it denied payment to North Carolina Medical Society members for medically necessary claims, without regard to individual patient medical needs.
- NCMS and three additional state medical societies brought the case in 2004 with the intention of forcing United to adjust its reimbursement practices.
- The bulk of the settlement—$9 million—will be applied to technology upgrades to United's provider self-service website to boost efficiency and cut down delays in claims management and resolution.
Dive Insight:
The goal of the lawsuit was to require the company to change its business practices, not obtain additional reimbursement, according to the Triad Business Journal. "We feel this lawsuit was the only way to force United to make the necessary changes to their business practice that would ensure that patient care is put in the hands of the physicians," said Robert Seligson, CEO of NCMS.
"Physicians will have simpler and more comprehensive access to claims management information through enhancements we are making to our physician website," United said in a statement.
Similar lawsuits have been filed against the company by additional medical societies in Connecticut, New York and Tennessee.