UMR, which is UnitedHealth-owned third party administrator (TPA), agreed to pay $20.25 million in a U.S. Department of Labor (DOL) suit over their process for review of emergency room (ER) claims. Vincent Micone III, acting DOL secretary, has asked the U.S. District Court for the Western District of Wisconsin to approve a consent order and judgment to resolve the pending court case.
In July 2023, the DOL filed a lawsuit alleging that UMR had violated the Employee Retirement Income Security Act (ERISA) by using erroneous procedures to review ER claims and ER urine drug test claims in over 2,100 employer-sponsored self-insured health plans. According to the DOL, UMR relied on final diagnosis codes instead of patients' symptoms in deciding these claims from 2015 through 2023. The DOL also accused UMR of rejecting all ER claims for patients' urine drug tests for four years of that period.
UMR claims that the processes that formed the subject of this litigation are no longer in place. While UMR doesn't agree with all the DOL allegations, the company agreed that resolving the case by signing the consent order and judgment was in the best interest of the plans and plan participants that it supports.
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