Texas is investigating whether UnitedHealthcare denied patient coverage in violation of state law
The state of Texas is investigating UnitedHealthcare’s business practices, including whether it is “denying patients the coverage they need and engaging in deceptive practices,” Attorney General Ken Paxton announced on Monday.
In the statement, Paxton said his office would be looking into whether or not the alleged actions of the insurance giant are “unlawful,” citing a number of unnamed media reports, including the story that UnitedHealthcare had “bribed nursing homes to delay hospitalizing patients who needed medical care,” first reported by The Guardian.
Attorney General Ken Paxton is investigating UnitedHealth Group, Inc. (“United”) for allegedly engaging in deceptive and unlawful practices that have denied Texans access to medically necessary healthcare.
Another case Paxton cited involved a Texas patient who received prior-authorization approval for a procedure at RedBud Surgery Center in Austin, only for UnitedHealthcare to allegedly pull the approval and refuse to reimburse care after the procedure was finished.
That patient, Paxton’s office said, was left with “a large medical bill.”
“Alarming reports keep piling up about how UnitedHealthcare treats Texas consumers,” Paxton said in the statement. “I will not tolerate any insurance company putting illegal corporate greed over the people of Texas.”
“No Texan should be denied medically necessary care, dragged through endless appeals, or stuck with devastating bills after trusting their insurer’s word. My office will gather the evidence, stand up to this multinational conglomerate, and make sure Texans get the coverage they pay for.”
Notably, UnitedHealthcare has previously denied many claims made in medical reports, going so far as to sue the Guardian for defamation—a complaint that was dismissed by a judge on First Amendment grounds.
DTPA violation?
As part of the probe, Paxton said his office has issued Civil Investigative Demands to UnitedHealthcare, under which the company will have to turn over certain records related to the specific concerns raised by the state.
While nothing has been concluded and the investigation is in its early stages, the attorney general is looking to collect evidence that UnitedHealthcare violated Texas state laws, in particular the Deceptive Trade Practices Act (DTPA), assuming any exists.
DTPA is a Texas law designed to protect consumers from false, misleading, and deceptive business practices. As part of its enforcement, consumers may sue with government backing in an effort to reclaim damages.
UnitedHealthcare has not publicly responded to the probe. HealthExec reached out to the company for comment.
