SEARCH

The Med. Soc'y of the State of N.Y. v. UnitedHealth Grp. Inc.

ERISA Not Violated by United's Denial of 'Facility Fees' for Doctor Office-Based Surgeries

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

FINDINGS OF FACT AND CONCLUSIONS OF LAW The central issue in this class action is whether a health insurer violated ERISA (the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§1001, et seq.) when it determined that physicians performing office-based surgeries in the state of New York are not entitled to a “facility fee.” Plaintiffs are two organizations — the Medical Society of the State of New York (“MSSNY”) and the Society of New York Office Based Surgery Facilities (“NYOBS”) — and a Manhattan medical practice, Columbia East Side Surgery, P.C. (“Columbia East Side”). Defendants are UnitedHealth Group Inc., United HealthCare Services, Inc., United HealthCare Insurance Company, United HealthCare Service LLC, Optum Group, LLC, Optum, Inc., and Oxford Health Plans LLC (collectively, “United”). A five-day bench trial was held before this Court in February 2022. The parties subsequently filed post-trial briefs and response briefs. (See Dkt. Nos. 349, 352, 355, 359.) The Court now issues its Findings of Fact and Conclusions of Law pursuant to Rule 52(a) of the Federal Rules of Civil Procedure. The Court assumes familiarity with the background of this case and the legal conclusions set forth in the Court’s prior opinions, which are deemed incorporated herein. (See Dkt. Nos. 59, 87, 153, 204, 214, 215, 289.) I. Findings of Fact A. Background for Adjudicating Claims 1. United’s Processes for Drafting and Vetting Plan Language United administers ERISA-governed health benefit plans. While some of these plans are fully insured, the majority are self-funded, which means that the plan sponsor pays any benefits and United acts only as a third-party administrator (known as “Administrative Services Only” or “ASO” plans). (Stip.

7, 21, 23.) A Certificate of Coverage (“COC”) governs fully insured plans and the terms of the ASO plans are described in a Summary Plan Description (“SPD”). (Stip.

More From ALM

Premium Subscription

With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now

Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now

Bundle Subscriptions

Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now

From Data to Decisions

Dynamically explore and compare data on law firms, companies, individual lawyers, and industry trends.

Exclusive Depth and Reach.

Law.com Compass includes access to our exclusive industry reports, combining the unmatched expertise of our analyst team with ALM’s deep bench of proprietary information to provide insights that can’t be found anywhere else.

Big Pictures and Fine Details

Law.com Compass delivers you the full scope of information, from the rankings of the Am Law 200 and NLJ 500 to intricate details and comparisons of firms’ financials, staffing, clients, news and events.

New York Legal Awards 2024

September 05, 2024
New York, NY

The New York Law Journal honors attorneys and judges who have made a remarkable difference in the legal profession in New York.

Learn More

BenefitsPRO Broker Expo 2024

April 29, 2024 - May 01, 2024
Aurora, CO

The premier educational and networking event for employee benefits brokers and agents.

Learn More

Pennsylvania Legal Awards 2024

May 15, 2024
Philadelphia, PA

The Legal Intelligencer honors lawyers leaving a mark on the legal community in Pennsylvania and Delaware.

Learn More

Truly exceptional Bergen County New Jersey Law Firm is growing and seeks strong plaintiff's personal injury Attorney with 5-7 years plaintif...

Apply Now ›

Labor & Employment Associate CT

Shipman is seeking an associate to join our Labor & Employment practice in our Hartford, New Haven, or Stamford office. Candidates shou...

Apply Now ›

BANKRUPTCY & COMMERCIAL LITIGATION ASSOCIATE

McCarter & English, LLP, a well established and growing law firm, is actively seeking a talented and driven associate having 2-5 years o...

Apply Now ›

Clifford Law Offices, PC

04/29/2024
The National Law Journal

Professional Announcement

View Announcement ›

MELICK & PORTER, LLP

04/15/2024
Connecticut Law Tribune

MELICK & PORTER, LLP PROMOTES CONNECTICUT PARTNERS HOLLY ROGERS, STEVEN BANKS, and ALEXANDER AHRENS

View Announcement ›

Apruzzese, McDermott, Mastro & Murphy, P.C.

04/11/2024
New Jersey Law Journal

Professional Announcement

View Announcement ›