From an appellate court reversing an order that would require UnitedHealth Group to reprocess thousands of denied claims, to former Molina employees suing the company over alleged Employee Retirement Income Security Act violations, here are five recent legal actions involving payers:
1. A federal appellate court reversed a pair of lower court decisions that required UnitedHealth Group's behavioral health unit to reprocess 67,000 previously denied mental health and substance abuse claims. The March 22 decision overturned a California federal judge's November 2020 order for United Behavioral Health to reprocess the claims and the judge's underlying March 2019 ruling in the class action lawsuit that the claims were improperly denied.
2. Aetna is facing a proposed class-action lawsuit for allegedly using a restrictive definition of "medically necessary" to avoid covering a patient's physical therapy. Court documents filed March 15 in the U.S. District Court for the District of Connecticut say Aetna must argue against allegations that it violated the Employment Income Retirement Security Act through its coverage limits.
3. Anthem could dodge a lawsuit that alleges the payer under-reimbursed Tampa, Fla.-based air ambulance company Jet ICU for providing out-of-network services to a beneficiary. A U.S. district judge for the Middle District of Florida Tampa Division ruled March 17 that Jet ICU will have more time to amend its original 2021 complaint against the payer. Jet ICU has "one final opportunity" to prove standing within 14 days.
4. A group of former Molina employees filed a lawsuit March 18 against the Long Beach, Calif.-based managed care company over alleged violations of the Employee Retirement Income Security Act. The complaint stems from flexPATH Index target date funds (TDFs). Plaintiffs said the TDF had never been used in an existing 401(k) and unperformed compared with established TDFs.
5. UnitedHealthcare received support from America's Physician Groups and America's Health Insurance Plans in its bid to have the Supreme Court reverse a federal appellate court's decision regarding Medicare overpayments.