Breaking News: Class Action Settlement Securing Past and Future PC-CP Payments from United Healthcare on Medicaid Line of Business

In July 2017, United Healthcare stopped making payments for PC-CP to its non-par providers on its Medicaid lines of business. Palmetto Pathology Services, P.A., and its physicians including Dr. Michael Abels and FSP past-president Dr. Luis Rey, along with Steven Weinstein of K&L Gates (corporate counsel for Palmetto Pathology and the FSP), and trial counsel Patrick Montoya with Colson Hicks, filed a class action lawsuit against UHC in 2019. On behalf of all Florida non-par hospital-based pathology groups, the class action lawsuit sought payment from UHC for all past and future PC-CP Medicaid claims, per AHCA's published Medicaid fee schedule.

On October 23, 2020, a class action settlement was reached on favorable terms to the pathologists. 

Dr. Mike Abels, one of the Palmetto litigants and an FSP Member wrote: “This victory would be hollow had Mort (Levitt, FSP President), you (Amy Young, FSP Lobbyist) and the (FSP) team not prevailed in rolling back the ACHA Medicaid fee schedule initiative. Everyone take a victory lap. Everyone be vigilant and watch payor policies.”

FSP counsel, Steve Weinstein, believes, "This is a significant win for all Florida pathologists who will now receive full PC-CP reimbursement from UHC on past and future Medicaid claims.  Moreover, it demonstrates that Palmetto Pathology and (your Florida Society of Pathologists) are willing to fight to secure proper reimbursement for these medically necessary professional services, for which they are liable and must be paid."

Here are the terms of the settlement:

  1. Scope of Class: United agreed to certify a class action to pay all Florida non-par hospital based pathologists under United's Medicaid  line of businesses, UnitedHealthcare Community Plan Medicaid, FHK, MediKids and CHIP who have not received payments from HMO members from July 1, 2017 through June 30, 2020.
  2. Past Payments at 100% of Florida Medicaid Fee schedule plus interest: United will make past payments to Florida hospital based non-par providers from July 1, 2017 through June 30, 2020.  For the claims for each Class Member it identifies, UHC will calculate the total amount reimbursable for the professional component of such services according to the applicable Florida Medicaid Fee Schedules, less 100% of any amount UHC previously reimbursed for such services, plus interest. To the extent a Class Member disputes the proposed amount of its Settlement Payment (e.g., because there are previously unsubmitted additional claims with dates of service from July 1, 2017 through June 30, 2020), each Class Member shall have the opportunity to have such additional claims included in UHC's calculation of the Settlement Payment by timely submitting them with its proof of claim, and the Settlement Agreement also provides a mechanism for the parties to analyze and resolve any disputes prior to payment of the Settlement Payment.
  3. Future Payments: Under the Settlement Agreement on August 1, 2020, United began to and will continue to make payments for covered claims in accordance with the Florida Medicaid Fee Schedule in effect as of the date of service.
  4. UHC has also agreed to pay the cost of the following: a) providing the class notice and Proofs of Claim, b) sending out, receiving and processing of Proofs of Claim, c) expenses for the Class Administrator, and d) attorneys' fees.
  5. Within the next 30 days, hospital based pathologists should expect to receive by mail a Class Notice that provide them with a link to a secured internet portal with UHC's calculation of their Settlement Payment for past claims, plus interest.

The legal team urges the pathologists to make their claims as soon as they receive the Class Notice stating that "The Settlement Agreement allows for claims to be made in the secured internet portal for 30 days from the date the Class Notice is mailed to the pathologists. So it is imperative that the groups watch their mail and make the claims timely in the internet portal. If a group does not make a timely claim, then it will be forever waived under the terms of the Settlement Agreement.”

Publication Date: 
Tuesday, October 27, 2020 - 12:00pm