Keller Rohrback Files New Claims Against UnitedHealth Group & OptumRx for Unlawful “Clawback” Scheme

January 24, 2017

Keller Rohrback Files New Claims Against UnitedHealth Group & OptumRx for Unlawful “Clawback” Scheme


January 24, 2017

Keller Rohrback L.L.P. has filed an Amended Complaint against UnitedHealth and OptumRx, as well as several of their affiliates. The latest complaint filed Friday, January 20, 2017, includes claims for violations of the Employee Retirement Income Security Act (ERISA) and Racketeer-Influenced and Corrupt Organization Laws (RICO), in addition to consumer protection statute and other state law claims.

The lawsuit intends to hold UnitedHealth, OptumRx, and their corporate affiliates accountable for a deceptive billing scheme known as a “clawback.” A clawback occurs when either the drug’s retail cash price—i.e., the amount paid by someone without insurance—or the negotiated price between the pharmacy and the plan provider is actually less than the amount the patient is required to pay at the pharmacy counter when using insurance coverage. For example, without health coverage, a drug may retail for $5.00 at a local pharmacy, but with insurance, the patient may be forced to pay a $20.00 “copayment” for the same drug. The $15.00 difference is then “clawed back” by the insurance company (such as UnitedHealth) or its “pharmacy benefit manager” (such as OptumRx).

This fraudulent “clawback” scheme is becoming more and more commonplace in the insurance industry. Humana and Humana Pharmacy Solutions, Inc., as well as Cigna with its prescription services through Catamaran (now owned by OptumRx) and Argus Health Systems, Inc. are alleged to be engaged in similar practices. Please visit our Rx Ripoff Resource Center for more information.

Keller Rohrback L.L.P. seeks to stop the unlawful and deceptive practice of overcharging consumers for life-saving medications. If you have a Humana, Cigna, or UnitedHealth health coverage plan through your employer, the ACA exchange, or Medicare, you may be paying artificially inflated prices for your prescriptions. Please contact an attorney to learn more about whether you too have been subject to unlawful “clawbacks.” Call 206.623.1900 or email [email protected].

Keller Rohrback L.L.P. has decades of experience helping consumers and insureds fight back against fraud and abuse. Keller Rohrback L.L.P. serves as lead and co-lead counsel in class action lawsuits throughout the country. With offices in New York, Seattle, Phoenix, Ronan, Oakland, and Santa Barbara, our Complex Litigation Group is proud to offer its expertise to clients nationwide. Our trial lawyers have obtained judgments and settlements on behalf of clients in excess of eighteen billion dollars.