UnitedHealthcare concludes multi-state agreement, assessed $14 million


UnitedHealthcare Insurance Co. and the National Association of Insurance Commissioners (NAIC) announced the conclusion of a settlement between the health insurer and the states that addresses a number of payment and compliance issues.

In addition to setting minimum standards, ensuring timely payment of claims and other performance and regulatory issues, UnitedHealthcare agreed to a $14 million assessment payable to the states.

The settlement involved 26 UnitedHealthcare entities in 41 jurisdictions, including UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare of New Jersey, UnitedHealthcare of North Carolina, and UnitedHealth Insurance Company of New York York and UnitedHealthcare of New York.

The settlement reaches back to 2007, when the company reached a regulatory settlement agreement with state insurance regulators to address past practices regarding timely payment of claims by the national health insurer. The company agreed to a plan that emphasized compliance, collaboration, innovation and continuous improvements that maximize performance for consumers and health care providers.

Susan Voss

Susan Voss

The agreement included minimum standards against which UnitedHealthcare’s performance would be measured in real time, escalating penalties for non-attainment, the payment of restitution when appropriate, and extensive assessment by an independent examiner.

The NAIC reported that UnitedHealthcare has met all metrics and compliance benchmarks set out under the settlement agreement.

“The course of action was guided by the principles of our state-based system of insurance regulation and was intended to foster regulatory coordination and efficiency through a framework for overall and sustained improvement,” said Susan E. Voss, former Iowa insurance commissioner who was part of the NAIC’s settlement team. “We are pleased to report a successful outcome and believe this is an important step toward quality improvement and regulatory compliance for UnitedHealthcare.”

In a statement issued by the company, UnitedHealthcare said it has created new best practices and is meeting performance standards.

“We are continuously enhancing our claim payment processes and customer service at UnitedHealthcare to meet the expectations of consumers, care providers, regulators and others we serve,” the statement said.

State regulators from Iowa, Arkansas, Connecticut, Florida and New York led the settlement actions. Commissioners from Pennsylvania, Washington, D.C., and Virginia participated in the settlement.



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