Jury Finds UnitedHealthcare Underpays TeamHealth Clinicians

UnitedHealthcare lost a round of litigation with TeamHealth, a Las Vegas jury decided on Monday.

UnitedHealth Group subsidiary underpaid TeamHealth for emergency services, the court ruled, which acknowledges the claims of a group of privately-backed providers that the nation’s largest insurer had lost $ 10.5 million to clinicians.

The verdict closes the book on the first of 10 cases the ambulance company is pending against the country’s largest insurer. TeamHealth subsidiaries in Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas are contesting UnitedHealthcare’s compensation.

UnitedHealthcare and TeamHealth did not immediately respond to interview requests.

The case was resolved Monday last month when TeamHealth subsidiary Fremont Emergency Services filed a lawsuit against UnitedHealthcare in Clark County, Nevada. Plaintiffs said UnitedHealthcare reacted to its 2019 pledge not to balance accounts for out-of-network patients by terminating its contracts with a group of providers and reimbursing them at unlawfully low rates. TeamHealth claimed that the insurer paid 80% less than its doctors charged.

In this and other cases, UnitedHealthcare objected that TeamHealth’s unreasonably high fees led to its removal from the insurer’s provider networks. Insurers argue that private equity holders are seeking additional profits, which drives up healthcare costs. Private equity firm Blackstone Group acquired TeamHealth for $ 6.1 billion in 2017.

TeamHealth instead claims that UnitedHealthcare is undermining providers for its own financial gain.

TeamHealth’s trial began days after UnitedHealthcare filed a separate complaint against a group of providers with the US District Court for the Eastern District of Tennessee. The insurer claims that TeamHealth deliberately and systematically tricked the insurer into paying more than $ 100 million in fraudulent claims.

UnitedHealthcare’s statements echo those of other insurers and an analysis of how private-owned supplier groups behave in the marketplace. According to these sources, companies like TeamHealth avoid contracts with insurance companies and charge high rates, leading to many unexpected bills that patients receive. TeamHealth disputes these findings.

When next year the No Surprises Act fully enters into force, limiting unexpected billing, balancing account for emergency services. Instead, payers and providers will have to come to an agreement or seek a decision from independent arbitrators.

This is a developing story.

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