NEW YORK CITY — A major health insurer with an office in Syracuse will pay $15.6 million and take other corrective actions following investigations and litigation by the New York State Attorney General’s office and the U.S. Department of Labor (USDOL). 

United Behavioral Health and UnitedHealthcare Insurance are part of Minnetonka, Minnesota–based UnitedHealth Group. UnitedHealthcare operates offices in Syracuse. 

An investigation by the USDOL’s Employee Benefits Security Administration found that United reduced reimbursement rates for out-of-network mental-health services going back to at least 2013. 

In doing so, the company was “overcharging participants” for those services, and flagged participants undergoing mental-health treatments for a utilization review, “resulting in many denials of payment for those services,” USDOL said. 

The $15.6 million includes payment of $13.6 million to affected participants and beneficiaries and more than $2 million in penalties, per a news release from the USDOL.

United’s action violated the Mental Health Parity and Addiction Equity Act of 2008. That law prohibits ERISA-covered health plans from imposing treatment limitations on mental health and substance-use disorder benefits that are “more restrictive” than the treatment limitations they impose on medical and surgical benefits.

ERISA is short for Employee Retirement Income Security Act.

Many participants and beneficiaries did not receive the mental health and substance-use benefits to which they were entitled under their ERISA-covered health plans due to United’s violations, USDOL said. 

Investigators also found United failed to disclose sufficient information about these practices to plans and their participants and beneficiaries. In the settlement, United agrees to stop the violations, improve its disclosures to plan participants, and “commit to future compliance.”

“In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before,” New York Attorney General Letitia James said in the release. “United’s denial of these vital services was both unlawful and dangerous – putting millions in harm’s way during the darkest of times. There must be no barrier for New Yorkers seeking health care of any kind, and I will always fight to protect and expand it. I thank Secretary Walsh for his partnership on this important matter.”

UnitedHealth Group reaction

In reaction, UnitedHealth Group sent the following statement to CNYBJ.

“We are committed to ensuring all our members have access to care and to reimbursing providers consistent with the terms of the member’s health plan and state and federal rules. We are pleased to resolve these issues related to business practices no longer used by the company. As part of our broader commitment to quality care, we continue to support our members with increased access to providers and new ways to get the effective behavioral support they need,” the company said.