NEW ORLEANS (WVUE) - A New Orleans-area attorney has joined the legal battle against the nation's largest health insurer, filing suit against UnitedHealthcare for overcharging customers for prescription medication.
It's now the third suit filed as a result of our Medical Waste investigative series.
According to the suit, United and its pharmacy benefit manager, Optum, overcharged an Alabama woman for prescription medication on 17 separate occasions this year. The suit also accuses United and Optum of engaging "in a scheme to defraud, by artificially inflating the copayment of prescription drugs, well above the cost of the drug."
"You actually, in many cases, would be better off if you didn't use your pharmacy benefit card at all," says plaintiffs' attorney Andrew Lemmon of Hahnville, "because the cash price is sometimes lower than the deductible and the copay that you end up paying."
FOX 8 News dug up similar findings in our series of reports in May, showing that several insurance companies, including UnitedHealthcare, overcharged customers for prescription drugs.
Pharmacists call it a "clawback"; the insurance company charges a premium on the cost of a drug and claws back the extra money.
On August 1 of this year, the Alabama woman paid a $40 copay for her prescription. The lawsuit alleges United and Optum inflated the cost of the prescription and clawed back $13 of the copayment.
"It is a surreptitious premium," Lemmon says. "It's not something that's disclosed to anybody, so it violates consumer protection laws and it violates other things - deceptive trade practices that were designed to protect consumers."
Lemmon is part of the legal team that filed this suit. The plaintiffs allege United "misrepresented and/or concealed the true copay prices of prescription drugs."
"The premium already is pretty high," Lemmon tells us. "And this is actually more of a premium that they're getting away from you, without actually telling you that you're paying a premium."
This suit references stories from our Medical Waste investigation and uses a graphic we published online to help explain how the clawback works.
Lemmon confirms, the complainants are not only asking for money; they're also asking the court to order United and Optum to end the clawback practices altogether. He says they want the pair "to follow what the contracts say and to follow what the consumer protection laws require - so that, when people go to a pharmacy, expecting to pay the lesser-of, that they actually pay the lesser of [the two costs, on insurance and off], and they're not paying an additional premium that they didn't authorize and they didn't expect to pay."
This is the second lawsuit filed against United in as many weeks. A separate group of attorneys filed a suit in a federal court in Minnesota, making similar allegations. That group has also sued another health insurer, Cigna.
Lemmon says he expects his team to file against even more companies, as they try to stop a secretive insurance practice that we discovered five months ago.
We asked UnitedHealthcare for its response to each of the lawsuits against it. So far, they have declined.