A second group of consumers has filed a potential class action lawsuit against insurance company UnitedHealth Group Inc. and some of its subsidiaries alleging the company engaged in health insurance fraud.
The UnitedHealth lawsuit specifically alleges that the health insurance company charges consumers excessive copayments for their prescription drugs that are greater than the cost of the drug itself, and then keep the difference as profit.
This practice of collecting excess payments from consumers that exceed the actual value of the drugs is referred to as copay clawbacks.
Essentially, the insurance company, in this case UnitedHealth, is clawing back money from patients who are purchasing prescription medications.
UnitedHealth Lawsuit Allegations
The lead plaintiff, Kathy Fellgren, said in her UnitedHealth lawsuit that the insurance company’s pharmacy benefit management (PBM) arm, OptumRx, improperly profits from customers overpaying for prescription drugs by paying an amount that exceeds the drug’s actual value.
She also alleges that the company makes pharmacists sign contracts with the company that include gag clauses, and these clauses are intended to stop pharmacists from protecting the consumers they serve.
Fellgren’s UnitedHealth lawsuit alleges that the company violated the Racketeer Influenced and Corrupt Organizations (RICO) Act and several consumer protection statutes as well as breached contract.
“The result, in many instances, is that insurance plans a nothing toward the cost of the covered individuals’ prescriptions, charge consumers an additional fee above and beyond the cost of their medications every time they fill a prescription, and leave patients financially worse off than if they had no insurance at all,” the UnitedHealth lawsuit states.
Fellgren explains that she was charged an additional $8 as a clawback on a drug that should have only cost her $1.61, her UnitedHealth lawsuit states.
She also cites another instance where a pharmacist disclosed that a $265 and 28 sent clawback was remitted to the health insurance company on a drug that only cost $3.27. She included additional examples from an investigation conducted by Fox eight News in Cleveland.
According to the gag clauses in the contract that pharmacists were required to sign, the pharmacists were required to charge a price for the drugs that they were essentially locked into, and they were specifically barred from telling customers the actual cost of the drugs and were banned from providing cheaper medication alternatives, the UnitedHealth lawsuit states.
According to the Fox 8 News segment that Fellgren referenced in her UnitedHealth lawsuit, the clawbacks received from consumers were used to be funneled back into reducing the healthcare costs of policyholders.
The UnitedHealth lawsuit states that many of the clawbacks were on generic drugs, and included the following: Alcortin A, Alprazolam, Cyclobenzaprine, Lisinopril, Meloxicam, Oxybutynin, Oxycodone, Raloxifene, Tizanidine, Valsartan HCTZ, Venlafaxine and Zonisamide. Brand-name drugs that included clawbacks were noted as Fluticasone, Invokamet and Diazepam.
The initial UnitedHealth class action lawsuit was filed on October 4, and it also alleged RICO violations in addition to Employee Retirement Income Security Act (ERISA) violations.
Following the submission of the second class action lawsuit, UnitedHealth released the following statement: “UnitedHealthcare’s pharmacy offerings will help customers and consumers save billions in prescription drug costs this year alone. Pharmacies should always charge our members the lowest amount outlined under their plan when filling prescriptions.”
The UnitedHealth Lawsuit is Fellgren v.UnitedHealth Group Inc. et al, Case No. 0:16-cv-03914, in the U.S. District Court for the District of Minnesota.
Join a Free Health Insurance Fraud Class Action Lawsuit Investigation
If you or a loved one were overcharged for a prescription drug, denied coverage or overcharged for a medical service, you may qualify to participate in a health insurance fraud class action lawsuit investigation. It’s absolutely free to participate, so act now!
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2 thoughts onUnitedHealth Lawsuit Accuses Company of Charging Excessive CoPays
Now if we could just get someone to investigate the inactive ingredients that’s not safe to everyone and is very dangerous and can cause allergic reactions to those of us who have allergies to food . Just because it’s a food safe grade ingredient doesn’t make it safe for many of us and yet the insurance companies will only cover the generic drugs . The FDA claims that they’re safe and allows it , the pharmaceuticals put the garbage in and the insurance companies push it . Where’s the accountability when they make those of us Sick .
You are so right. Was in ICU for lisinopril for 4 days face looking like a duck