Envision Healthcare receives $91.2M in judgment against UnitedHealthcare

Photo: Pichsakul Promrungsee EyeEm/Getty Images

Envision Healthcare was awarded more than $91 million by an independent arbitration panel on March 30, in its arbitration against UnitedHealthcare for underpayment of essential medical care, the company revealed this week.

In addition to the award, the panel will separately assess prejudgment interest and decide Envision's entitlement to attorney's fees, costs, and expenses as a prevailing party.

The three-member panel was comprised of American Arbitration Association arbitrators. The issue revolves around care that Envision provided to UnitedHealthcare members in 2017 and 2018. At the time, Envision and UnitedHealthcare had an in-network agreement, but according to Envision, UnitedHealthcare "unilaterally" reduced reimbursement to Envision clinicians in violation of the network agreement. 

The award essentially compensates Envision for UnitedHealthcare's breach of contract.

WHAT'S THE IMPACT

Envision has other lawsuits against UHC that are still pending.

UHC removed Envision from its network in 2021, claiming the firm's costs did not reflect fair market rates. According to a lawsuit that Envision filed last fall, UHC denied about 18% of submitted commercial claims – a number that swelled to 48% of all claims after Envision's removal from UHC networks, the firm said.

And for the highest-acuity claims, Envision accused UHC of denying 60% of those claims.

In a statement at the time, Evision alleged that UHC "puts profits above all else, including patients and the physicians and advanced practice providers who provide life-saving care in emergency rooms across the country."

In response, UnitedHealthcare filed its own lawsuit against Envision, alleging the firm deliberately upcoded thousands of claims and deceived UHC into overpaying millions of dollars for emergency care.

UHC claimed it had approached Envision with evidence of upcoding, and accused the firm of hurriedly filing a lawsuit to beat UHC to the courthouse.

THE LARGER TREND

This hasn't been the only legal entanglement for UnitedHealthcare. In 2021, UHC sued another physician firm, TeamHealth Holdings, alleging fraud for over-inflating medical codes to get greater reimbursement.

UnitedHealthcare alleged that since 2016, TeamHealth has upcoded claims and committed fraud by misrepresenting the services provided.

TeamHealth, in response, filed suit against UHC alleging the insurer's shared savings plan encouraged the underpayment or termination of physician contracts. The suit claimed UHC underpaid on 11,000 claims for a total of about $10.5 million.

A Clark County, Nevada, jury agreed with TeamHealth that United engaged in unfair reimbursement practices by deliberately failing to pay frontline emergency room doctors adequately for care provided to patients. The jury assessed about $60 million in punitive damages against UnitedHealthcare, finding it was guilty of fraud and malice in its conduct.

ON THE RECORD

"While we are very pleased with the outcome," said Jim Rechtin, CEO of Envision Healthcare, "it should not take five years to get paid for the lifesaving care our clinicians provide. We currently have three other lawsuits against UnitedHealthcare, which will likely take several more years to resolve. It is challenging to create a stable environment for our teams when health plans choose not to pay their bills."
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com