UnitedHealth suffered a major blow to its image this week when a legal advocacy group filed a lawsuit claiming that the health plan's policy of allowing doctors to make final
decisions over medical care is a "sham."
The lawsuit, filed earlier this week, was brought by The REPAIR Team, which stands for RICO and ERISA Prosecutors Advocating for Insurance industry Reform. It alleges that
UnitedHealth violated the Racketeer Influenced and Corrupt Organizations (RICO) Act and the Employee Retirement Income Security Act (ERISA).
The suit notes that three weeks after the health plan announced a "final say" physician policy in November, it contradicted itself with private practices outlined in a
Physicians Reference Guide. REPAIR identified discrepancies that range from doctors still needing pre-certification for MRIs, CAT-Scans, physical therapy and other medical
conditions to United emphasizing "report cards" that rate doctors according to how their treatment decisions affect the company's bottom line.
A UnitedHealth spokesman did not return phone calls. But the health plan said in a press statement that, while it has not yet seen the lawsuit, it believes the suit will be
found to be without merit. The health plan also says that doctors, consumers and legislators have praised its "final say" program.
(REPAIR, Dick Scruggs, 228/762-6068; UnitedHealth, Lee Newcomer, 612/936-7212)