UnitedHealth provider cuts spur legislation

Legislation that would prohibit Medicare Advantage plans from dropping doctors in the middle of the year has been introduced in the House and Senate. The proposal was spurred by controversial cuts to provider networks over the past year by UnitedHealth Group.

The legislation was introduced by Rep. Rosa DeLauro (D-Conn.) and Sen. Sherrod Brown (D-Ohio). Both of their home states were impacted by United's provider cuts last year.

Doctors in Connecticut filed a lawsuit contesting the practice and won an injunction requiring the company to establish a process for doctors to contest the decision.

“The timing and scale of UnitedHealth Group’s provider cuts have been extremely disruptive to their Connecticut patients and put them at risk,” DeLauro said in a statement. “We have a responsibility to ensure that Medicare Advantage plans are serving the needs of their participants.”

The legislation would require Medicare Advantage plans to finalize their networks 60 days before the annual open enrollment period. They would then be prohibited from dropping doctors without cause prior to the next sign-up period. In addition, it would require private Medicare plans to disclose their reasons for dropping providers.

In recent weeks, UnitedHealth has been notifying doctors in at least six states that they are being dropped from networks. Providers in Alabama, Georgia, Massachusetts, Missouri, North Carolina and Tennessee are affected by the changes.

Roughly 30% of Medicare beneficiaries are now enrolled in private plans. Despite payment reduction that were part of the Patient Protection and Affordable Care Act, the roles have continued to swell in recent years.

In a statement, a spokesperson for United defended the adequacy of the company’s provider networks. “We continue to offer Medicare Advantage enrollees a broad choice of primary care physicians and specialists in Connecticut and elsewhere, and are committed to ensuring Medicare beneficiaries have access to quality, affordable care,” said Terence O’Hara.

Follow Paul Demko on Twitter: @MHpdemko



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