Los Angeles-based law firm Hooper, Lundy & Bookman filed the amended class action complaint. The amended complaint accounts for the “expanded scope of the misconduct that has come to light” since the original filing, HLB said in a news release. Additionally, HLB added United’s client plans as defendants in the suit.
In 2009, HLB filed a class action complaint on behalf of all ASCs across the country, charging United and Ingenix with underpricing the payments owed to non-contracted ASCs. The original complaint charged that United and Ingenix violated ERISA, RICO and the California’s Business & Professions Code.
United had represented to ASCs that it had calculated usual, customary and reasonable rates by comparing the charges of ASCs in the applicable geographic region through use of its Ingenix database. However, the firm’s attorneys allege they have confirmed United did not calculate UCR rates by comparing the charges of ASCs in the geographic region. In addition, the firm claims it learned that United often did not use the Ingenix database at all for ASC claims, even when representing that Ingenix had been used. Instead, for many if not most claims, United simply used its in-network or Medicare rates as a baseline, coupled with what appears to be an arbitrary multiplier, when paying out-of-network claims to ASCs.
“In addition to the millions of dollars in damages to ASCs, we feel that United’s underpricing of these claims also adversely affects the patients,” Plaintiff Co-counsel Glenn Solomon said in the release. “These plans are marketed to members as providing the freedom and flexibility to choose out-of-network providers, and plans charge higher premiums for this supposed choice. However, United’s underpayment scheme discourages patients from exercising that choice, and results in an illusory right to choose when they do try to exercise it.”
Read the HLB release on the ASC class action suit against UnitedHealth.
Read the amended class action complaint (pdf).
