UnitedHealth, OptumRX targeted in latest class-action suit alleging prescription scam

By Carrie Salls | Nov 27, 2016

NEW ORLEANS – A UnitedHealth Group Inc. plan participant has filed suit against the insurance company for allegedly overcharging for prescription drugs after New Orleans television station Fox 8 revealed the findings of its investigations into prescription drug costs.  

In a segment entitled “Medical Wa$te,” Fox 8’s Lee Zurick investigated the “rising costs of prescription meds and questionable practices by the pharmaceutical and insurance industries.”


The class action complaint filed by Kathy L. Fellgren on Nov. 15 in the U.S. District Court for the District of Minnesota is at least the third lawsuit in roughly six weeks filed in connection with UnitedHealth’s relationship with pharmacy benefit manager OptumRx.


Specifically, the lawsuit alleges that UnitedHealth and OptumRx charge “hidden bogus fees” to customers whose prescriptions cost less than the policyholders’ copayment. If the copayment amount is more than the retail price of a prescription drug, the class action complaint alleges that UnitedHealth and OptumRx “claw back” the extra amount. The lawsuit alleges these clawed back amounts are “pure, undisclosed profits.”


“These excess payments by patients for their prescription drugs are collected by benefit defendants, who have concocted a scheme to unlawfully pocket the difference between the amount the patient is required to pay at the pharmacy counter and the actual price of the drug,” the complaint said.


Some pharmacy benefit managers often collect for themselves more than the prescription costs, while the patient’s insurance plan provides no benefit to the patient, the complaint alleges.


In addition to the alleged clawback scheme, Fellgren also claims that UnitedHealth is employing “gag clauses,” which require pharmacists not to tell their patients how much their prescription drugs actually cost and prohibits them from providing lower-cost alternatives to their patients or disparaging the insurance company or pharmacy benefit manager in any way.


Since pharmacies that violate the gag clauses could potentially lose hundreds of thousands of customers, “most pharmacists have concealed the practice,” the lawsuit said.


“Americans who go to the pharmacy for needed medications expect to be charged a fair price, especially if insurance is involved,” the complaint said. “Indeed, the majority of Americans enroll in or purchase insurance plans specifically to reduce the cost of their medications and to reduce their out-of-pocket expenses for what is often life-saving care.”


Other lawsuits were filed on Oct. 4 and Oct. 14 in connection with UnitedHealth’s relationship with OptumRx, and Cigna Corp. and Humana have been the targets of lawsuits containing similar allegations to the one filed by Fellgren.


All of these complaints cite Fox 8’s investigation into health insurance clawbacks. The station said the investigation revealed that some insured patients would pay less for the prescription drugs in question if they had not had prescription coverage at all.


All of the known lawsuits filed against UnitedHealth, Cigna and Humana assert claims under the Racketeer Influenced and Corrupt Organizations Act.


In response to possible overcharging schemes, Louisiana Gov. John Bel Edwards signed legislation in June that attempts to curb overpayments for prescription drugs.


The class in Fellgren is seeking restitution, monetary damages, injunctive relief and/or other available remedies for losses suffered.

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Organizations in this Story

Humana OptumRx, Inc. UnitedHealth Group

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