UHC Fined for Errors in Provider Directories

On 12/19/06, Attorney General Eliot Spitzer announced a settlement that will require United Healthcare (UHC) to stop providing misleading information to its policyholders and to provide restitution to consumers.

"Consumers should not be saddled with improper bills when they rely on health plan directories to choose their doctors," said Spitzer. "Health plans must accurately list participating providers so that patients can maximize their coverage and keep their costs as low as possible."

The case began when the Attorney General’s Health Care Bureau received a complaint from a consumer who had received services from a doctor erroneously listed as participating in UHC’s Empire Plan network. Because UHC then processed the consumer’s claim as one for out-of-network services, she had to pay the difference between the amount the doctor billed and the amount UHC paid, a much higher sum than the co-pay she would have paid for an in-network, participating doctor.

An investigation revealed that United erroneously listed certain doctors as participating in the Empire Plan at certain locations. The Empire Plan provides health coverage for more than one million active and retired state and local government employees and their dependents. The New York State Department of Civil Service relied on this erroneous information in its written and online directories of providers for Empire Plan members. These errors, which UHC attributed to computer programming problems, first occurred in 2000 and were included in its published directories until October 2005. The errors were corrected in the online directory in May 2004.

In addition to correcting the errors in its directories, UHC agreed to review Empire Plan claims back to January 2000 to identify all claims that were improperly processed and reimburse all members who incurred costs higher than the co-pay for in-network care.