Appeals court affirms ruling in UnitedHealth billing case

An appeals court affirmed its ruling that UnitedHealth Group isn't allowed to offset overpayments made to out-of-network providers from some of its health plans by withholding payments to the same provider from its different health plans, according to Law 360.

Three things to know:

1. The United States Court of Appeals for the Eighth Circuit affirmed its ruling in a Jan. 15 filing. The ruling concerns cross-plan offsetting, through which UnitedHealth recovers any overpayments to in-network providers under agreements that allow the health insurer to offset the overpayment through withholding the overpaid amount in subsequent payments.

2. In 2007, UnitedHealth expanded its cross-plan offsetting practices to out-of-network providers. Class-action lawsuits were filed against the health insurer in 2014 and 2015 by two out-of-network providers challenging the cross-plan offsetting practices. The cases were later consolidated. While UnitedHealth argued the plaintiffs weren't authorized to bring their actions and that cross-plan offsetting is allowed, the court disagreed.

3. In its Jan. 15 filing, the court affirmed its previous agreement with the plaintiffs: "The plaintiffs, litigating under the Employee Retirement Income Security Act ['ERISA'] on behalf of their patients, the plan beneficiaries, claim the relevant plan documents do not authorize United to engage in cross-plan offsetting. The district court agreed and entered partial summary judgment to the plaintiffs on the issue of liability. United appealed the summary judgment order. We affirm."

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