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Insurer “way over the line” loses challenge against levied fines

On Behalf of | Feb 14, 2019 | Insurance Disputes

It’s always news when the Goliath in a given industry suffers a stern court rebuke, and it’s thus unsurprising to see recent accounts involving a setback for UnitedHealthGroup receive major press coverage.

UHG is the biggest insurance company in the United States, and it has been locked in an outsized litigation dispute with the California Department of Insurance since 2014. Insurance Commissioner Dave Jones imposed $173 million in fines against the insurance giant that year relating to a staggering 908,547 patient-linked violations. UHG clawed back, with the matter remaining both acrimonious and unresolved through successive levels of court decisions.

Until last month, that is, when California’s Supreme Court decided not to weigh in on an appellate court ruling upholding a trial court’s decision that found against UHG. The high court’s decision affirms the insurer’s duty to pay the Commissioner’s office $91 million. The remainder of the 2014 $173 levy remains under appeal.

Jones, who has since left office, is now being lauded in some quarters for his resolve in going after UHG and its PacifiCare subsidiary for alleged bad-faith conduct on a mass scale. The current commissioner says that the insurer’s internal practices resulted in patients “who were in desperate need of health care services being denied coverage and access to medical care.”

Jones did comment in the wake of the court’s ruling, stressing his belief that the remaining $82 million in fines still being appealed will eventually have to be paid by UHG.

“I’m confident the department will win,” he said.

Although the case holding applies only to California, commentators stress its national implications. One states that “insurers across the country have been put on notice by this case.”