Jury orders UnitedHealthcare to pay TeamHealth more than $60M for underpaying clinicians
The damages follow last week's verdict in which the jury ruled that UnitedHealth failed to adequately pay ER doctors.
Photo: Blanchi Costela/Getty Images
On Tuesday, a Clark County, Nevada jury awarded $60 million in punitive damages to three Nevada-based TeamHealth affiliates in their case against UnitedHealthcare for unfair payment and reimbursement tactics.
The awarding of punitive damages follows last week's verdict, in which the Nevada jury ruled that United deliberately failed to pay frontline emergency room doctors adequately for care provided to patients.
In that verdict, the jury unanimously found that United was guilty of "oppression, fraud, and malice" in its conduct.
During trial, evidence showed that United paid as little as 20% of billed charges. In one instance, United only allowed a $254 charge for a gunshot wound billed at $1,428. When questioned, former UnitedHealth executive John Haben said saving somebody's life was "worth" the $1,428 charged.
Haben also revealed that United exposed its members to surprise medical bills and would only pay if a member complained.
The court also highlighted UnitedHealth's role in allegedly colluding with Yale University professor Zack Cooper to produce a controversial study promoting the view that TeamHealth engaged in balance billing and ignored the insurer's financial incentive to terminate provider-network participation and profit under its shared savings plan provisions with employers.
WHAT'S THE IMPACT?
Though that particular suit is now settled, there remains UnitedHealth's lawsuit against TeamHealth, which claims that since 2016 TeamHealth has upcoded claims and committed fraud by misrepresenting the services provided.
The UnitedHealth plaintiffs reviewed tens of thousands of commercial health benefits claims submitted by TeamHealth and determined that well over half the claims TeamHealth submitted to UHC using the two highest level CPT codes for ER visits – roughly 60% – should have used lower-level CPT codes for treating routine health problems, such as sore throats and ear infections.
TeamHealth operates one of the largest emergency room staffing and billing companies in the United States. It affiliates with or acquires medical groups across the country that have contracts with hospitals and health systems under which the medical groups staff hospital emergency rooms, according to UHC.
"But this is where the medical groups' involvement ends," the lawsuit said.
TeamHealth handles coding and billing from centralized billing centers, and then submits the claims to insurers under the name of its affiliate or acquired medical group.
No ER physician profited, UHC said. Physicians were paid a flat, hourly rate.
THE LARGER TREND
TeamHealth was acquired by private equity firm Blackstone in 2017. Since then, TeamHealth has made an "aggressive pursuit of profit" that has drawn the ire of patients, insurers and the government, UHC said in its lawsuit.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
