North Carolina fines UnitedHealthcare $3.4M for improper billing practices

RALEIGH, N.C. — North Carolina Insurance Commissioner Mike Causey has fined UnitedHealthcare $3.4 million for violations in claims handling practices involving balance billing, the state Department of Insurance announced last week.

The fine stems from a four-year investigation that revealed UnitedHealthcare failed to protect members from unexpected out-of-network charges, particularly in emergency room and anesthesia services.

Investigators found the insurer did not consistently follow its own procedures to negotiate with providers and prevent members from bearing excessive financial burdens. The investigation began after sustained complaints from members and health care providers.

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“Patients receiving emergency room services certainly don’t have the time or capacity to go through a checklist and make sure all providers attending them are in-network,” Commissioner Causey said. “UnitedHealthcare’s practices potentially put unnecessary financial burdens on many North Carolinians. I am happy to see that UnitedHealthcare has agreed to take corrective action.”

Specific violations included subjecting members to cost-sharing beyond standard deductibles, copayments, and coinsurance for medically necessary services performed by out-of-network providers at in-network facilities.

The report found that when members filed grievances, UnitedHealthcare often denied their complaints without attempting to help members avoid additional charges. The DOI report found that UnitedHealthcare would at times respond with an adverse decision letter saying, “You are responsible for all costs related to this service,” or “You may be responsible for paying the difference between what the facility or provider billed and what was paid.”

While UnitedHealthcare accepted the final report and voluntary settlement agreement, the company expressly denied violating any statutes or regulations.

As part of the settlement, the insurer must submit a corrective action plan to the Department of Insurance and agree to future compliance examinations. The $3.4 million fine will be distributed to public schools, as required by the North Carolina Constitution.

The results of the investigation come two months after the insurer’s CEO was gunned down outside of a Manhattan hotel. Luigi Mangione, 26, has since been arrested and charged in the killing. In December 2024, Mangione pleaded not guilty to state murder and terror charges, in a case that will run parallel to his federal prosecution.

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