A group of anonymous Apple Inc. (Nasdaq: AAPL) and Tesla (Nasdaq: TSLA) employees reached a key legal milestone in their complaint against United Behavioral Health and MultiPlan over underpayment for out-of-network care. 

On Oct. 3, Judge Yvonne Gonzalez Rogers, of the U.S. District Court for the Northern District of California, signed an order granting the plaintiffs’ third motion to certify a class. The complaint was originally filed in April 2020.

The plaintiffs allege that United Behavioral Health’s use of MultiPlan’s rate pricing technology created a fraudulent scheme to underpay providers. In the process, they further alleged the practice enriched Multiplan and United Behavioral Health, harmed plan members and violated provisions of the Employee Retirement Income Security Act (ERISA) and the Racketeer

Influenced and Corrupt Organizations Act (RICO Act). The case is titled LD v. United Behavioral Health.

United Behavioral Health is part of the health care-payer conglomerate UnitedHealth Group (NYSE: UNH).

In previous attempts, the courts denied certification attempts due to their inability to satisfy the numerosity or predominance requirements for a class certification. In this ruling, the judge found that the plaintiffs satisfied the numerosity requirements by identifying at least 37 class members that were impacted by the alleged underpayments. It also found that the question of alleged violations predominates any need for addressing claims on an individual basis.

“The law requires no fixed minimum size for a class to be sufficiently numerous, though many courts have held that a class of forty members is presumptively appropriate,” the order reads. “To reach a threshold of forty, therefore, they need not extrapolate across the whole class at the same rate. They merely need to present sufficient evidence to allow the Court to infer that at least three class members exist who paid on balance bills from other providers.

“In a putative class numbering in the thousands, this inference is more than reasonable.”

In an amended complaint, the plaintiffs allege that the “putative plaintiff class includes hundreds of thousands, and possibly millions, of mental health and substance use disorder treatment patients throughout the United States.”

A representative of United Behavioral Health declined to comment on this story. Attorneys for the plaintiffs did not respond to a request for comment as of the time of publication.

While not directly related to national or state parity laws, the underpayment element of the case resonates with common complaints across the industry about the collective payer system treating behavioral health as a second-class care modality and plan benefit. Rather than denying the claims, the plaintiffs allege that United Behavioral Health severely underpaid for out-of-network intensive outpatient programs that treated mental health and substance use disorder (SUD) conditions. The most recently amended complaint from the plaintiffs finds that the payment rates developed by Multiplan at the behest of United Behavioral Health only covered between 11% and 25% of what benchmark data would have suggested was a usual, customary and reasonable rate.

This development marks another procedural victory for plaintiffs seeking redress against United Behavioral Health in federal courts.

Earlier in the year, a district court affirmed core contentions of the long-running case Wit v. United Behavioral Health after years of appeals. That case also involved the certification of a class, which comprises approximately 65,000 people.

In February 2024, the U.S. Supreme Court declined to hear a case involving the denial-appeals process of United Behavioral Health. Previous rulings in that case, in part, help specify the need for health plans to meaningfully engage with a patient’s clinicians in assessing appeals.