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UMR, a third-party administrator owned by UnitedHealth, has agreed to pay at least $20.25 million to resolve a U.S. Labor Department civil suit over claim-review processes.
Vincent Micone III, the acting secretary in charge of the department, has asked two judges at the U.S. District Court for the Western District of Wisconsin to approve a consent order and judgment that could end the case, according to a motion that was filed with the court Friday.
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The department sued UMR in July 2023 over allegations that UMR had violated the Employee Retirement Income Security Act of 1974 by using faulty procedures to review emergency room claims and ER urine drug test claims submitted on behalf of participants in 2,140 employer-sponsored self-insured health plans.
The department accused UMR of basing decisions about ER claims filed from 2015 through 2023 on the final diagnosis codes, rather than on the patients' symptoms.
The department accused UMR of rejecting all of the ER claims for urine drug tests conducted on the patients from 2015 through 2018.
Related: U.S. Labor Department sues UnitedHealth Group subsidiary over denied claims
UMR has not agreed with all of Micone's views, such as his statements about the scope of his authority, but it has signed the consent order and the judgment, according to the Labor Department motion.
Labor Department attorneys filed the motion with U.S. District Judge William Conley and Magistrate Judge Anita Boor.
Boor issued an order Friday scheduling a telephone status conference for 2 p.m. Feb. 28. The conference will be canceled if the parties settle the case before then.
Representatives for the Labor Department could not immediately be reached for comment.
UnitedHealthcare, the UnitedHealth unit that oversees UMR, said the proposed settlement involves administrative processes that are no longer in place.
"We have been in ongoing negotiations with the DOL and have now reached a resolution that we believe is in the best interest of the plans and enrollees that we support," UnitedHealthcare said.
Julie Sue, who was the acting Labor secretary under former President Joe Biden, was running the department when the department filed the suit.
Micone, who took over as the acting head of the department Jan. 21, was named to his post by President Donald Trump. The case docket shows that the department and UMR submitted a negotiations progress notice with the court Feb. 4.
Questions about how the department oversees self-insured health plans could come up Wednesday when the Senate Health, Education, Labor and Pensions Committee holds a hearing on the nomination of Lori Chavez-DeRemer to be Labor secretary. Chavez-DeRemer is the wife of an anesthesiologist.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
