UnitedHealth executive’s testimony in court hints at problems with MultiPlan

Meanwhile, UnitedHealthcare filed a lawsuit against TeamHealth in the US District Court for the Eastern District of Tennessee in late October, claiming that the emergency team deliberately and systematically tricked the insurance company into paying more than $ 100 million in fraudulent claims.

TeamHealth did not provide a response by the due date.

UnitedHealthcare did not respond to an interview request.

UnitedHealthcare will not comment on its external partners and contracts, MultiPlan wrote in a letter to shareholders on Monday.

“Customers still wanted to use the wrap networks, the alleged payment negotiations that MultiPlan provides, and we were ready to do that,” Haben said in court. “We’re not going to force the client to move.”

In 2023, UnitedHealthcare planned to move its self-funded clients from MultiPlan to an internal program that it estimates will save more than $ 300 million in annual provider fees, according to an internal insurer document that TeamHealth submitted in evidence. court. UnitedHealthcare is still asking for some evidence to be edited, and the court ruled that the document will not be released until a judge decides whether the slide is relevant to the case.

But the documents partly support claims made in last year’s short-selling report, which MultiPlan vehemently denies. The report claimed that UnitedHealthcare – MultiPlan’s largest client – was phasing out its services. The report says UnitedHealthcare represents a third of the MultiPlan business.

It came months after Multiplan went public with a $ 11 billion special-purpose company, and some analysts questioned whether the deal represents a real upside opportunity or solves the looming bond maturity problem faced by MultiPlan. When the report was released, the company also faced questions about how it would remain relevant after the No Surprises Act took effect in 2022.

MultiPlan said it plans to grow by investing in new lines of business and targeting payers outside of traditional insurers. Others argue that MultiPlan services offer insurers a “legal shield,” allowing them to blame their low rates on the provider rather than on their own solutions.

MultiPlan continues to rebut the short selling report, saying that revenue from UnitedHealthcare has grown more than 30% in the past three years and that the two companies have partnerships that MultiPlan expects after 2022.

“The false claim that UHC is ending its relationship with MultiPlan has been perpetuated by short sellers motivated by their own economic interests,” writes MultiPlan. letter to shareholders Monday.

But many investors believe UnitedHealthcare is developing its own alternative to MultiPlan. In a June policy document, UnitedHealthcare Naviguard is described as a “leading off-chain offering” to enable employers to resolve disputes with service providers.

Naviguard was not designed to replace MultiPlan and is currently offering a different set of services, Haben said.

According to Haben, Naviguard is an internal customer advocacy tool that helps members understand their benefits, refer patients to on-chain providers, and eliminate any out-of-pocket costs. He added that MultiPlan offers a network of supplier agreements, negotiation services, emission cost management, and fraud and waste prevention tools.

Haben did not immediately respond to an interview request.

The “UHC termination” rumor has been exploited by opportunistic short sellers to profit by cutting MultiPlan shares and other securities, “MultiPlan wrote to shareholders on Monday morning.

This is not the first time the company’s management has turned to its relationship with UnitedHealthcare.

In July, MultiPlan said it did not expect the policy change for UnitedHealthcare to have a “material impact” on its finances in 2021.

In the same month, UnitedHealthcare launched an out-of-network claims termination program where fully insured customers seek non-emergency care outside of their local coverage area. A week after the updated UnitedHealthcare rules were announced, MultiPlan’s share price fell 25%.

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