UNITED PETITIONS THE SUPREME COURT FOR CERTIORARI OF EIGHT CIRCUIT DECISION FINDING UNITED’S POLICY OF CROSS-PLAN OFFSETTING TO BE UNREASONABLE

 

UnitedHealth Group has petitioned the Supreme Court for certiorari of the Eight Circuit Court of Appeals decision finding its policy of cross-plan offsetting to be unreasonable.  Under the policy, United offsets alleged overpayments made by self-funded plans to out-of-network medical providers by withholding payments to those providers by other self-funded plans.  In other words, if United determines that a self-funded plan for which it serves as the third party administrator has overpaid an out-of-network provider, United withholds payments due to that medical provider from another self-funded plan for which it also serves as the third party administrator.  The Eighth Circuit found the policy to be unreasonable, stating:  “To adopt United’s argument that the plan language granting it broad authority to administer the plan is sufficient to authorize cross-plan offsetting would be akin to adopting a rule that anything not forbidden by the plan is permissible.”

In its petition for certiorari, United asserts that the Eighth Circuit decision conflicts with decisions in the Third, Fifth, and Seventh Circuits, and it asks the Supreme Court to resolve the conflict.

Whatley Kallas, LLP has found numerous instances in which health plans have used cross-plan offsetting to withhold payments to our provider clients.  We will continue to monitor developments in this case and will report on the Supreme Court’s decision on the petition for certiorari.

The case is UnitedHealth Group, Inc. et al. v. Louis J. Peterson, on behalf of patients E, I, K, L, N, P. Q, and R, et al., case number 18-1498.