United Behavioral Health and United Healthcare Insurance have agreed to pay a total of $15.6 million and take corrective actions to resolve violations of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
The U.S. Department of Labor (DOL) announced the news Thursday following investigations and litigation by the DOL and the New York State Attorney General.
The development is a positive sign for behavioral health providers — and evidence that the Biden Administration is making good on its promise to enforce parity in the U.S. health care system, according to Acting Assistant Secretary of Labor for Employee Benefits Security Ali Khawar.
“Enforcing the MHPAEA is a very high priority for the Department of Labor in this administration, and it really has been since the beginning of this administration,” Khawar said Thursday during a press conference. “The Secretary of Labor views this as probably our top health enforcement priority for [the Employee Benefits Security Administration].”
UnitedHealth Group (NYSE: UNH) is the nation’s largest insurance company in terms of revenue. And this isn’t the first time it’s been hit with parity lawsuits.
For example, earlier this year, a California federal judge ruled that the company had violated federal benefits law and MHPAEA when it refused to cover certain autism therapy services. The company also came under fire in 2019 and 2020 for its behavioral health coverage guidelines, which a federal judge deemed too restrictive. That lawsuit is currently pending on appeal.
The most recent lawsuit and settlement comes after an investigation found that, going back to at least 2013, United reduced reimbursement rates for out-of-network mental health care, thus overcharging beneficiaries for services. Additionally, the company flagged participants receiving mental health treatment for utilization review, often resulting in payment denials.
According to the DOJ, those actions violate MHPAEA, which prohibits health plans under the Employee Retirement Income Security Act (ERISA) from covering behavioral health treatment more restrictively than medical and surgical care.
As part of the settlement, United Behavioral Health and United Healthcare Insurance will pay $13.6 million to affected participants and beneficiaries, while another $2.08 million will go toward penalties. Plus, United agreed to take other corrective actions, such as ceasing violations, improving its disclosures to plan participants and committing to future compliance.
Additionally, going forward, participants and beneficiaries will no longer have to submit onerous documentation, such as proof of having been balance-billed by providers, to receive their money, Solicitor of Labor Seema Nanda said during the press conference.
“This reflects the department’s long standing position that denial of benefits in and of itself is an injury, and that requiring workers to submit extensive proof reduces legitimate benefits paid under these settlements,” she added.
Khawar and Nanda went on to say more federal parity investigations are coming, in part thanks to new tools introduced as part of the Consolidated Appropriations Act of 2021.
Matt Wolfe — partner at the law firm Parker Poe and vice chair of the Behavioral Health Task Force for the American Health Lawyers Association (AHLA) — said that’s all good news for the behavioral health providers who work payers bound by MHPAEA.
“I would anticipate that either directly or indirectly, as a result of this settlement, that United will change some of its policies and practices that gave rise to these lawsuits — in particular, the non-quantitative limitations on behavioral health services that are more restrictive than policies and practices for medical or surgical treatment,” Wolfe told Behavioral Health Business.
He went on to predict additional parity-related regulatory efforts from state and federal governments in the months and years to come. Specifically, he pointed to the 21st Century Cures Act and the Consolidated Appropriations Act of 2021 to support that claim, both of which “added teeth to parity from a regulatory perspective.”
“It’s going to be easier for [the government] to ensure that parity requirements are enforced through administrative means, rather than primarily through litigation means,” Wolfe said. “That’s really the direction that I anticipate seeing more and more priority enforcement going toward.”