Optum Fined $20,000 By The DMHC

The Department of Managed Health Care has levied a $20,000 penalty on UnitedHealth's behavioral health plan for engaging in unfair payment patterns and denying provider claims after they were already authorized.

The penalty and fines were levied on Jan. 15 against Optum Health after a survey conducted by DMHC in 2011 found that 11 of 20 claims sampled had had their payment authorization rescinded after services had already been provided to an Optum enrollee. In another survey, five of 50 claims were rejected for no authorization even though authorization had already been issued by Optum.

In claims that were under dispute, the DHMC found that in three instances Optum failed to pay the correct amount and interest and that its provider dispute mechanism did not function correctly.

According to the DMHC, a health plan has engaged in an unjust or unfair payment pattern if it unfairly rescinds payment authorizations three times or more in a three month period or does not pay at least 95% of claims in a timely manner. 

Along with paying the fine, Optum Health has also agreed to take corrective action in order to avoid such conduct in the future.

The DMHC has levied 14 penalties and fines against Optum Health's parent company, U.S. Behavioral Health of California since May 2009. The fines have totaled $227,500, including a $100,000 fine for moving claims processing to overseas locales without notifying the agency.