The North Carolina Department of Insurance has fined UnitedHealthcare $3.4 million for improper billing practices. The fine comes after a four-year investigation revealed the insurer failed to protect its members from unexpected out-of-network charges. Insurance Commissioner Mike Causey said, “Patients receiving emergency room services certainly don’t have the time or capacity to go through a checklist and ensure all providers attending them are in-network.
UnitedHealthcare’s practices potentially put unnecessary financial burdens on many North Carolinians.”
The investigation began after the department received sustained complaints from members and healthcare providers. Specific violations included subjecting members to cost-sharing beyond standard deductibles, copayments, and coinsurance for medically necessary services performed by out-of-network providers at in-network facilities.
Insurance fines for billing errors
When members filed grievances, UnitedHealthcare often denied their complaints without attempting to help them avoid additional charges. The insurer would sometimes respond with an adverse decision letter stating, “You are responsible for all costs related to this service” or “You may be responsible for paying the difference between what the facility or provider billed and what was paid.”
UnitedHealthcare accepted the final report and voluntary settlement agreement but denied violating statutes or regulations. As part of the settlement, the insurer must submit a corrective action plan to the Department of Insurance and agree to future compliance examinations.
The $3.4 million fine will be distributed to public schools, as the North Carolina Constitution requires. The investigation’s results come two months after the insurer’s CEO was killed outside a Manhattan hotel. Luigi Mangione, 26, has been arrested and charged in the killing.