United allegedly applied an algorithm to identify and deny medically unnecessary services to nearly all outpatient psychotherapy services while only using a corresponding outlier technique on a limited group of medical/surgical outpatient services. The DOL’s complaint also alleged that United applied its outlier management strategy disproportionately to mental health benefits. The DOL concluded that this inconsistent approach to applying rate reductions for out-of-network mid-level providers violated the comparability and stringency requirements of the parity law. Further, United did not articulate any consistent factors that were used to determine which providers were subject to the reductions, and United hid the reimbursement rate reductions from members and providers by failing to mention them in plan documents and explanations of benefits. In contrast, United did not impose a discount for medical services for most non-physician providers of medical/surgical services, such as nurses or physical therapists. Specifically, the insurer artificially depressed reimbursement rates for nonphysician providers of psychotherapy, reimbursing psychologists 25 percent less and master’s degree-level counselors 35 percent less than physicians providing the same service. While United reduced reimbursement rates for certain out-of-network mental health treatments, the insurer did not comparably reduce reimbursement for out-of-network medical/surgical treatments. This improper behavior allegedly dated back to at least 2013. and United Behavioral Health of illegally reducing reimbursement rates for out-of-network behavioral health services and targeting mental health recipients for claim reviews, leading to many denials of coverage. United Behavioral Health, et al., the DOL accused United Healthcare Insurance Co. The DOL has enforcement authority over plans that are subject to the Employee Retirement Income Security Act (ERISA), which includes most private-sector health plans. The MHPAEA applies to plans sponsored by private- and public-sector employers with more than 50 employees, and to health insurers who sell coverage to employers with more than 50 employees. The MHPAEA is a federal law that requires health insurers and group health plans to ensure that financial requirements, such as copayments and deductibles, and treatment limitations for mental health and substance use disorder benefits are comparable or on parity with those for medical/surgical benefits. But the $15.6 million settlement is a drop in the bucket for the nation’s largest health insurance company, which earned $4.9 billion in profits in Q1 2021 alone, so it may not be enough to deter large health insurers from continuing to flout the law. The case is a win for mental healthcare providers and patients, and it sends a clear signal that the Biden administration is stepping up enforcement of the MHPAEA. Department of Labor (DOL) to enforce the parity law against a health insurer or group plan in the statute’s 13-year history. was the first lawsuit brought by the U.S. project/token/src/common/currency_token.In a landmark case, United Healthcare agreed to pay $15.6 million to settle allegations that it violated the Mental Health Parity and Addiction Equity Act (MHPAEA). And also let's build a couple of such ledgers. Let's now implement it! Let's build a simple token canister that allows multiple ledgers to listen for various events happening in this token.
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