UnitedHealthcare to pay $11.5M for alleged systematic payment denial

Health insurer UnitedHealthcare will pay $11.5 million to resolve allegations it systematically denied payments to physicians to achieve financial targets, according to a Triad Business Journal report.

The allegations are contained in a decade-old lawsuit brought by the North Carolina Medical Society. In its 2004 lawsuit, NCMS alleged UnitedHealthcare "would systematically deny payments to NCMS members for medically necessary claims to achieve internal financial targets without regard for individual patient medical needs," according to the report.

The vast majority ($9 million) of the settlement proceeds will be used for upgrades to the health insurer's provider self-service website in order to increase efficiency and reduce claims management delays. The remaining $2.5 million will be paid to the North Carolina Medical Society Foundation for physician education programming, according to the report.

UnitedHealthcare released a statement saying, "We are pleased to have resolved this … litigation and look forward to collaborating in new ways with the North Carolina Medical Society," according to the report.

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