United Healthcare Fined for MHPAEA Violations

United Healthcare Fined for MHPAEA Violations

An investigation by the Department of Labor’s Employee Benefits Security Administration (EBSA) has revealed that, since at least as far back as 2013, United Healthcare Insurance and United Behavioral Health (“United”) engaged in a series of actions in violation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). See United Behavioral Health, United Healthcare Insurance Co. plans to pay $15.6M, take corrective actions after federal, state investigations | U.S. Department of Labor (dol.gov)

As a reminder, MHPAEA prohibits ERISA-covered health plans from imposing treatment limitations and requirements on mental health and substance abuse disorder (MH/SUD) benefits that are more restrictive than limitations on medical and surgical – i.e., non-MH/SUD – benefits.

DOL found that United violated MHPAEA by disproportionately conducting utilization reviews on participants who were undergoing mental health treatments, thereby resulting in denial of service payments. United also reduced reimbursement rates for mental health services provided out-of-network, thereby resulting in overcharging patients. Finally, DOL determined that United failed to disclose these practices to plan participants and beneficiaries.

As part of the settlement, United will:

  • Pay $13.6 million to affected participants
  • Pay nearly $2.1 million in penalties
  • Cease MHPAEA violations
  • Improve plan disclosures
  • Commit to future compliance

The settlement is an indication from DOL that it is committed to enforcing MHPAEA and ensuring service parity between medical, surgical, mental health, and substance abuse disorder benefits.

Next steps:

As a reminder, the Consolidated Appropriations Act of 2021 imposes new comparative analysis reporting requirements. Read our previous article on this topic here. Mental Health Parity Guidance Issued (cbiz.com)

Plan providers and issuers should take advantage of the DOL’s MHPAEA Self-Compliance Tool to review their plans. Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA) (dol.gov)

The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. This information is provided as general guidance and may be affected by changes in law or regulation. This information is not intended to replace or substitute for accounting or other professional advice. You must consult your own attorney or tax advisor for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.

United Healthcare Fined for MHPAEA Violationshttps://www.cbiz.com/Portals/0/Images/Mental health parity faq.jpg?ver=PYdWpWVe_B11Nwb1qiQdOA%3d%3dEmployers should use the DOL Self-Compliance Tool to avoid similar pitfalls.2021-10-07T19:00:00-05:00Employers should use the DOL Self-Compliance Tool to avoid similar pitfalls.Regulatory, Compliance, & LegislativeEmployee Benefits ComplianceNo