January 7, 2016 / 5:11 AM / 3 years ago

NY orders UnitedHealth to pay $100,000 to settle antitrust probe

WASHINGTON (Reuters) - The New York Attorney General has ordered UnitedHealth Group to pay a $100,000 fine after an investigation found the insurance provider engaged in anti-competitive practices involving elder and long-term care products, according to a person familiar with the matter.

The settlement, which was signed late Wednesday, centers on efforts by UnitedHealth to force nursing homes to purchase other additional unwanted insurance services in order to participate in the insurance carrier’s broader network, the person added.

The person spoke to Reuters anonymously, because the settlement has not yet been made public.

In addition to paying a fine to settle the case, UnitedHealth also agreed to cease its practice of requiring nursing homes to purchase multiple insurance products.

“Our nation’s elderly, and those that care for them, face tremendous financial pressures at this time,” New York Attorney Eric Schneiderman said in a statement provided to Reuters.

“Free and fair competition among service providers is crucial to ensure that patients receive the highest levels of service at the lowest possible costs.”

The New York case is focused specifically on so-called “institutional special needs plans.”

Such health plans aim to provide care for people with chronic health problems who are in need of care for at least 90 days.

Insurers who offer such plans must get approval first from the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid. Once approval is received, an insurer can be licensed to do business in certain geographic areas for up to three years.

UnitedHealth is the largest provider of privately run Medicare Advantage plans in a number of counties across the state and it also has a very large slice of the insurance business for institutional special needs plans.

The person said that UnitedHealth used its clout in the marketplace to wrongfully force nursing facilities that wanted to accept UnitedHealth’s commercial or Medicare Advantage plans to also participate in UnitedHealth’s institutional special needs plan.

Doing this in turn disadvantaged some of UnitedHealth’s competitors in New York, which include ArchCare, Independent Health, Centerlight, Elderplan Inc and Healthfirst.

The investigation, which had not been previously reported, was sparked by complaints about the company’s conduct.

UnitedHealth is settling the case without admitting or denying any wrongdoing.

“We work with providers who will help the people we serve receive the high quality care they need to get and stay healthy, and we are pleased that the state recognizes that,” a company spokesman said.

Reporting by Sarah N. Lynch; Editing by Eric Walsh

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