On Tuesday, US Chief Magistrate Judge Joseph Spero issued his decision against United Behavioral Health (a subsidiary of UnitedHealthcare), accusing them of focusing on the bottom line more than patients’ health and illegally denying treatment to thousands of people. He also “slammed the company’s medical directors for being ‘deceptive’ under oath.”1 The ruling will now move to a remedy phase so that punishment can be determined. (Although the company was found guilty in federal court, Spero ruled that United Behavioral Health also violated state laws in Illinois, Connecticut, Rhode Island, and Texas.)


Spero criticized the insurer for effectively creating internal policies that discriminated against people who sought mental health and substance abuse treatment:

“It is well-established that effective treatment of mental health and substance use disorders includes treatment aimed at preventing relapse or deterioration of the patient’s condition and maintaining the patient’s level of functioning. UBH Guidelines deviate from that standard.”1

Here are just a couple of the judge’s comments (he did take the time to blast UBH’s medical directors and expert witnesses responsible for setting company policy, furthering naming each one and taking them to task):1

  • “UBH’s experts, on the other hand, had serious credibility problems. The Court found that with respect to a significant portion of their testimony each of them was evasive — and even deceptive — in their answers when confronted with contrary evidence.”
  • He remarked that one board-certified psychiatrist and senior medical director “was not always credible because in several instances he ignored the plain meaning of the words used in the Guidelines.”
  • For the expert responsible for drafting coverage determination guidelines, he said they had implemented a “model that keeps benefit expenses down by placing a heavy emphasis on crisis stabilization and an insufficient emphasis on the effective treatment of co-occurring and chronic conditions.”
  • He also accused them of ignoring “effective treatment of members’ underlying condition” and “knowingly and purposefully” drafting guidelines “to limit coverage to acute signs and symptoms.”
  • He concluded by saying it was clear that one of the biggest drivers of their policies was profit

For their part, UnitedHealthcare took issue with the judge’s comments and said they looked forward to demonstrating how their members received appropriate care.


The class-action suit was brought on behalf of more than 50,000 people denied coverage by United Behavioral Health and took the judge more than a year to issue (his decision was 106-pages). This decision is thought to be one of the “most important and most thorough rulings ever issued against an insurance company, at the federal level, on mental health issues.”1


  1. CNN