UnitedHealth to fine physicians if patients go to ’wrong’ lab
Healthcare Auditing Weekly, February 26, 2007
Effective March 1, the UnitedHealth Group will fine a physician $50 if a patient goes outside the insurer's network for lab services, American Medical News reports.
The sum represents the cost difference to UnitedHealth between nonparticipating and participating laboratories, according to the article.
Physicians could also face further sanctions if patients continue to use out-of-network labs, including a "change of eligibility" in UnitedHealth's pay-for-performance and quality-rating programs, a "decreased fee schedule," or termination from the plan's network.
The American Medical Association (AMA) and state medical societies sent letters to United protesting the intent to fine doctors. While plans have used various means to fight paying out-of-network rates, medical society executives said they can't think of a case in which plans bluntly assessed financial penalties on physicians for their patients' decisions.
Click here to read the entire News story.
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