UnitedHealthcare Fined $100K For Substance Abuse Care Violations

PROVIDENCE, RI — A health insurance provider in Rhode Island is facing a $100,000 from the state for failing to follow state law in care for people suffering with substance use disorder, the Office of the Health Insurance Commissioner announced. UnitedHealthcare used criteria inconsistent with state law when determining levels of care, the statement said.

Rhode Island law requires that health insurance providers follow the guidelines established by the American Society of Addiction Medicine, which aim to improve the system of addiction treatment and focus on results-based care. From 2015 through 2018, UnitedHealthcare did not meet this requirement, the agency determined.

"Moreover, the criteria UnitedHealthcare used were also inconsistent with generally accepted standards of care among substance use treatment providers," a statement from OHIC read in part. "This material inconsistency, more likely than not, would have affected coverage decisions for members in a manner resulting in clinically inappropriate coverage decisions."

UnitedHealthcare will be forced to pay a $100,000 fine and take actions to ensure the guidelines are met in the future.

In response to the announcement, Gov. Dan McKee reiterated the state's commitment to making substance abuse and behavioral health care accessible.

"Now more than ever, it is critical that our Administration hold health care entities accountable for ensuring parity between physical and behavioral health care," McKee said. "I thank the Office of the Health Insurance Commissioner for their full review of this matter and for continuing to hold health insurance companies accountable when their practices are not consistent with Rhode Island law. Rhode Islanders deserve fair and adequate access to the care they need and our Administration will continue to ensure that happens."