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August 04, 2023

DOL Sues UnitedHealth Group for Improper Denial of ER Claims

In a complaint filed on July 31, 2023, the Department of Labor (DOL) alleges that UnitedHealth Group’s third party administrator, UMR, improperly denied thousands of emergency room and urinary test claims. The DOL alleges that UMR denied emergency claims based on diagnosis codes and failed to apply the “prudent layperson standard" required by ERISA. The suit also claims that UMR violated both the ACA and the government's rules for internal claims procedures through the third-party administrator’s explanation to members about the denied emergency claims. 

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