TeamHealth’s allegations that UnitedHealthcare closed 11,500 claims worth $ 10.5 million were referred to Clark County, Nevada District Court on Tuesday, with the claims reflecting nine other claims that the privately held provider is considering against the nation’s largest insurer, all blaming UnitedHealthcare for underpaid bills by tens of millions of dollars.
UnitedHealthcare’s latest lawsuit is simply an attempt to distract from the Las Vegas case, TeamHealth wrote in an email. Ahead of the trial, the insurer tried to use coding as a defense, but the court dismissed the charge, the company said.
“UnitedHealth’s Tennessee lawsuit last Thursday over coding violations and the associated blitz press is undoubtedly an attempt to influence the Las Vegas jury in a way that UnitedHealth could not directly do,” TeamHealth said.
Read More: UnitedHealthcare Sues TeamHealth, Charges Fraud
In its lawsuit, UnitedHealthcare argued that TeamHealth deliberately and systematically tricked the insurer into paying more than $ 100 million in fraudulent claims. The company’s claims echo those of other lawsuits and scientific analysis, although the insurer contributed to the main research into TeamHealth’s impact on healthcare costs.
In 2017 Yale University researchers After analyzing more than 2 million claims from one major insurer, it was found that when TeamHealth took over the management of several predominantly non-profit emergency services, payment for out-of-network services increased. The number of tests ordered, the use of the highest billing code, and the number of patients coming from the emergency department to the hospital have also grown, although not at the rate of off-network billing. In terms of access to the company’s claims data, the initial study did not identify UnitedHealthcare as an insurer, although court documents TeamHealth Leaked To The Intercept it was later revealed that researchers at Yale University relied on company accounts to conduct research.
It was the first major study that unexpectedly billed staffing companies owned by private shareholders, and ultimately helped persuade Congress to pass the Surprise Ban Act. Effective January 1, 2022, the law prohibits billing for emergency services and off-chain cost sharing, forcing providers and payers to negotiate a price or negotiate a dispute with an independent arbitrator.
TeamHealth’s claims represent an attempt to distract from TeamHealth’s unreasonable and high demands from payers, which in the first place led them to drop out of the UnitedHealthcare network, a UnitedHealthcare spokesman wrote in an email. According to the spokesman, the company’s private equity holders are seeking additional profits, which contributes to higher health care costs in general. Private equity firm Blackstone Group acquired TeamHealth in 2017 for $ 6.1 billion.
“We are committed to combating these unreasonable and anti-competitive rates that many healthcare staffing companies charge for services that add to the cost of service for our customers, members and the healthcare system,” said a UnitedHealthcare spokesperson.
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TeamHealth says researchers’ dependence on UnitedHealthcare data spoils their results. The company also claims that UnitedHealthcare used “biased” research to manipulate the average contract rate it offers to TeamHealth, ensuring that the rate any arbitrator decides once the new law comes into effect is lower than the market demands.
The questions about the data agreement between Yale researchers and UnitedHealthcare are “very unfair,” have “ethical preferences,” and are “completely a hit,” said Erin Duffy, a fellow at USC’s Schaeffer Center for Health Policy and Economics.
“A lawsuit related to setting on-net rates for 2019 could be a signal that someone is trying to influence the respective payment amounts in the future, but none of these lawsuits address this,” Duffy said of complaints from UnitedHealthcare and TeamHealth. “I think these lawsuits could have come out anyway.”
TeamHealth’s Las Vegas case was filed on behalf of its subsidiary Fremont Emergency Services, claiming UnitedHealthcare divested doctors 11,500 claims worth $ 10.5 million in 2019. As a result, the insurance giant terminated all of its on-net contracts and began reimbursing companies at unlawfully low rates, TeamHealth said.
In one case, TeamHealth doctors treated a patient with a gunshot wound and United reimbursed less than a fifth of the debt, TeamHealth lawyers said. In other cases, claims were paid 80% less than they requested.
By underpaying TeamHealth’s clinicians, TeamHealth said, UnitedHealthcare was able to widen the gap between the savings it achieved for its self-insured clients and getting the spread. Emails and other documents from UnitedHealth Group officials show that contract cancellations generate more than $ 1 billion in revenue annually, according to the company.
The company is seeking damages in the amount of $ 10.5 million, as well as penalties.
“At the end of this case, we will ask you to say ‘enough, enough.’ We’re going to ask you to say, “Make them stop changing us to reimburse us for what we are entitled to pay,” said Pat Lundwall, partner at McDonald Carano law firm representing TeamHealth, at the opening. arguments in the Las Vegas court.
The Las Vegas charges reflect the claims of other TeamHealth lawsuits, the company said in an email.