UnitedHealth Group, Minneapolis, agreed to pay a $2.2 million fine to settle allegations by the North Carolina Department of Insurance that two UnitedHealth plans failed to promptly fix claims-payment problems and resolve complaints from doctors and hospitals.
The company did not admit wrongdoing under the voluntary settlement. According to the department, a new claims-processing system paid some claims using out-of-date fee schedules, failed to recognize valid payment codes, denied payment for preauthorized care, and flagged some network doctors as nonpreferred providers.
"Over time, we concluded that these were not isolated cases and that system changes by the companies were needed," state Insurance Commissioner Jim Long said in a news release.
UnitedHealth estimated that 100,000 claims -- or 1% of the 10 million claims it processes annually in North Carolina -- were not paid properly. The company submitted to regulators a report of steps being taken to fix the system and agreed to keep regulators apprised of the progress.
How much UnitedHealth owes providers in back payments isn't known, although an insurance department spokeswoman said the amount could "easily" be in the millions of dollars.
The nation's largest insurers, including UnitedHealth, face a sweeping class-action lawsuit alleging that the companies systemically shortchanged more than 900,000 physicians for their services.