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The U.S. Department of Labor has filed a lawsuit against UMR alleging that the subsidiary of UnitedHealth Group improperly denied thousands of emergency department and drug screening claims without assessing their merit. UMR is a third-party administrator that contracts with almost 2,140 self-funded plans to adjudicate their claims.
In the complaint filed last week, Labor Secretary Julie Su asked the court to order UMR to bring its procedures for handling claims in line with the law and re-adjudicate claims denied since 2015. The complaint alleges that UMR determined whether to pay emergency services claims by comparing the diagnostic code provided to two code lists, True ER and the Sudden and Severe list. If a patient had a diagnosis not included on one of those lists, UMR allegedly denied the claim without any further review.
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