News
Article
What We’re Reading: UnitedHealth Sued Over Denied Claims; Alzheimer Drug Cost to Taxpayers; Maternity Care Access Worsens
Author(s):
The US Labor Department initiated a lawsuit against a UnitedHealth Group unit after it allegedly denied thousands of claims without assessing their merit; the cost of lecanemab, the first drug that claims to slow the advance of Alzheimer disease, will mostly fall upon taxpayers; nearly 7 million women in the US live in maternity care deserts with little to no access to maternal care.
US Labor Department Sues UnitedHealth Over Denied Claims
The US Labor Department initiated a lawsuit on Monday against a UnitedHealth Group unit alleging that it denied thousands of emergency department and drug screening claims without reviewing whether they were medically necessary, according to Modern Healthcare. The complaint targets UMR, a third-party administrator within the company’s UnitedHealthcare subsidiary. The Labor Department accused UMR of violating the Employee Retirement Income Security Act of 1974 and denying claims without assessing their merit. This lawsuit comes a week after a class-action lawsuit was filed against Cigna due to its alleged use of the computer algorithm PXDX to automatically reject patient claims without reviewing them individually.
New Alzheimer Drug Cost Falls Mostly on Taxpayers
Lecanemab (Leqembi), the first drug that appears to slow the advance of Alzheimer disease, may cost the US health care system billions annually despite the barriers to access for many lower-income seniors, according to KFF Health News. Eisai Co, the company that sells the drug, claimed that Medicare and Medicaid patients will make up 92% of the market for Leqembi. According to estimates from the Institute for Clinical and Economic Review, the drug costs $26,500 annually, and treatment could cost US taxpayers an average of $82,500 per patient each year for care, including frequent brain scans and genetic tests. About 1 million patients in the United States could qualify for Leqembi, which received full FDA approval on July 6.
Access to Maternity Care in the US Continues to Worsen
Nearly 7 million women in the United States have little to no access to maternal care, according to USA Today. The March of Dimes’ 2022 report defined 1119 counties as “maternity care deserts,” which are counties without a hospital or birth center offering obstetric care and without any obstetric providers. In total, the nonprofit organization designated 36% of US counties as maternity deserts, 61% of which were rural counties. The number of maternity care deserts has increased by 2% from the 2020 report, leaving 15,933 additional women without maternity care.
