Attorney Joe Saunders, of Pinellas County, filed a class action suit against UnitedHealthcare yesterday. The lawsuit accuses UnitedHealthcare of Florida of misrepresentation and fraudulently marketing some of their health care plans.
According to the lawsuit, the defendants, UnitedHealth Group and UnitedHealthcare, enrolled Medicare recipients into their Medicare Advantage HMO or PPO plan without authorization from the client. Also the company did not inform the client that enrolling them into the Medicare Advantage plan disenrolls them from the Medicare Program.
The Medicare Advantage plans, such as Secure Horizons and Complete Care, provide only limited or no skilled nursing home case, require people to pay expensive copays, and limit the number of doctors patients can visit. UnitedHealthcare has been accused of using fraudulent marketing practices by using the names Secure Horizons and Complete Care that imply that these plans cover the same amount as the Medicare Program. In actuality Medicare covers much more, such as paying 100% for nursing home care up to 20 weeks, provides patients with a larger choice of doctors, and copays are less expensive.
The case came about when Charleen Edge, Saunders’ mother, was tricked into a Medicare Advantage plan without her knowledge. Apparently, Edge was contacted by UnitedHealthcare and was told that her old plan was expiring and being replaced by the new Part D program. The company recommended that she add two AARP policies- a cheap supplement plan and the new drug plan. But instead UnitedHealthcare enrolled her in their Medicare HMO plan which only pays bills for certain doctors.
When Edge found out that she was not on the plan she had requested she asked the company to disenroll her. Both of her complaints were unanswered, but when Saunders complained UnitedHealthcare finally took her off the plan. However, when Edge broke her pelvis a few months later and had to be rehabilitated in a nursing home, Medicare rejected her $30,000 medical bills. Medicare stated that UnitedHealthcare had re-enrolled Edge into the HMO plan two months before her accident.
Saunders believes that there are many other people who have had the same problems with their insurance companies and is now waiting to see if a judge will certify that UnitedHealthcare HMO members represent a class of people suitable to mass litigation.