The U.S. Supreme Court has declined to consider review of a decision by the Court of Appeals for the Second Circuit in a case alleging violations by United Healthcare of the federal Mental Health Parity and Addictions Equity Act (MHPAEA).
The case, New York Psychiatric Association (NYSPA) et al. v. United Healthcare, has been remanded to U.S. District Court to proceed to discovery and trial.
Representatives for NYSPA told Psychiatric News that the association will continue to work on a legal strategy as the case moves forward.
“NYSPA is very pleased that the Supreme Court has declined to consider review of the Second Circuit Court of Appeals decision,” Seth Stein, J.D., executive director and general counsel for NYPSA said. “In a precedent-setting decision released this August, the Second Circuit held that United, as claims administrator, was a proper defendant in the case and also held that NYSPA has associational standing at this point in the litigation to represent the interests of its members and their patients. The case has been remanded to federal District Court, and NYSPA will continue to work with its attorneys on legal strategy as the case moves forward. We hope to expand the scope of the litigation to examine existing disparities in reimbursement between behavioral health benefits and medical-surgical benefits. In addition, we would like to further address the issue of United’s interference with access to care by means of stringent medical necessity review standards imposed on behavioral health benefits.”
The lawsuit was brought by NYSPA and several patients, a member psychiatrist, and a psychologist in March 2013 alleging that UnitedHealth Group and subsidiaries, including United Behavioral Health, systematically violated the federal parity law and the Affordable Care Act. NYSPA joined the suit on behalf of its members and their patients.
At that time, Stein told
Psychiatric News that NYSPA had fielded numerous complaints from its members about denial of mental health and substance use treatment by United (
Psychiatric News, April 5, 2013).
The circuit court’s ruling in August recognized that NYSPA could represent its members and their patients in pressing a claim under MHPAEA through “associational standing.” Both APA and the AMA filed amicus briefs on behalf of NYSPA, emphasizing that associations have traditionally been permitted to represent their members’ interest in litigation that is consistent with the mission of the association and that physicians are permitted to represent the interest of their patients.
Also, the court decision recognized that United could be sued even when it acted not as the insurer but as the administrator of a self-insured plan. This means that the carriers are at risk under MHPAEA whenever they exercise discretion in the administration of benefits and that employees do not have to sue their employer (as United argued) to recover benefits (
Psychiatric News, October 16). ■
