NEW ORLEANS (WVUE) - A federal class action lawsuit has been filed against the insurance company UnitedHealthcare. The suit alleges United secretly overcharged customers for prescription drugs. The suit is based on a series of investigations by FOX 8 News called Medical Waste.
"Cheated, highly cheated," says one United customer, a Slidell woman who pays high premiums for her insurance. She thinks United overcharged her $15 for a thyroid medication.
"I have found, looking at my receipts, that more of my prescriptions than not I could buy cheaper without my insurance," she tells us. "I feel cheated. And everyone else should too."
Our series of stories questioned the country's largest health insurer's practice of overcharging customers for some prescriptions. Pharmacists call it a clawback.
Here's an example of how it works. Valsartan HCTZ, a high blood pressure medication, costs $14.43. But a document obtained by FOX 8 shows the pharmacist was instructed to collect a $30 copay. United clawed back $15.57 from the pharmacy and customer; the company is paying nothing toward the prescription here.
"Every time the customer comes in, they're making more money because the patients needed the prescription," said a pharmacist who asked to remain anonymous.
In these cases of clawback, essentially, it would be cheaper for customers to pay it out of insurance.
Pharmacists across the country gave us hundreds of examples, including a $22 clawback on the nasal spray Fluticasone, $7.85 for a diabetes treatment, Invokamet, $12.39 for Diazepam, a drug that treats anxiety, muscle spasms and seizures.
"As a fraud investigator, I think it's fraudulent," said Susan Hayes with the firm Pharmacy Outcomes Specialists in an interview for our investigative series. "It's a fraudulent misrepresentation of what the patient has really paid. The patient did pay the $150, but the pharmacist didn't get to keep the $150. The PBM clawed back $140 of it. So the cost of the drug is really $10. Why did the member just get $10? Why does the pharmacy have to get this amount clawed back?
United customers in New York, New Jersey and Michigan filed suit in a Minnesota federal court, where United's corporate office is located.
"We believe that's an inappropriate practice, under the clear language of the insurance policy," says Bob A. Izard, one of the attorneys representing the plaintiffs.
That suit alleges the "defendants insured [that] patients pay undisclosed, unauthorized and excessive fees for prescription drugs." The suit quotes many of the findings in our series, and also uses many of the documents we published on our website.
"We think our clients and all customers should be reimbursed for the amount of these excess payments that they made over time," Izard tells us. "We also think that, going forward, United should change its practices. And when the policy says that the most you should pay is the amount that the pharmacy receives for filling prescription, well that's the amount the customer should pay."
The suit alleges that the "clawbacks are most common with widely used drugs," and names 24 medications believed to be involved in the alleged scheme. The plaintiffs say there could be even more such meds.
In our stories, we introduced you to 11-year-old Isa Zorrilla. She had never heard of the word "copay", but she quickly caught on.
"If someone would charge you, you'd pay like some of it to them," she said, "and then someone else would pay some of it. Like copilot - copay.
Instead of a copay, we labeled it a "you-pay" - because you are the only one paying.
It's a term the plaintiffs' attorneys used in their filing.
"Copayment is defined under a section called 'cost sharing,' says another attorney for the plaintiffs, Craig Raabe. "That is, a shared cost between the insurer and the insured. And if this clawback and payment back to the insurance company is occurring, it is not a copayment at all."
The plaintiffs' filing calls United's practice a "scheme to defraud." The attorneys say they've heard from other United customers, and more could join this suit - a suit that, if successful, could put money back in the pockets of United customers who were charged a premium on their prescription drugs.
"I'm very angry, I'm very annoyed," says another United customer we interviewed for this update. "And I feel like it's a big fraud. I think that a lot of elderly people are being defrauded."
We reached out to United for a statement on the lawsuit, but haven't received anything.