UnitedHealthcare loses another lawsuit to TeamHealth in billing fight

Photo: Blanchi Costela/Getty Images

UnitedHealthcare, the nation's largest insurer, has lost its latest legal battle against provider group TeamHealth, with a three-judge arbitration panel in Florida ruling late last week that TeamHealth was owed $10.8 million due to underpayments from UHC from 2017 to 2020.

While TeamHealth said it expects additional awards, in the "millions of dollars," for prejudgment interest and costs, UHC said the provider group was only awarded a fraction of what it was seeking and that the monetary judgment was undeserved. 

According to a statement from TeamHealth, the arbitration panel "relied on convincing evidence that United paid the group 30% of the amount the judges determined to be the fair payment for the care provided – and United today continues to pay at this egregiously low rate."

WHAT'S THE IMPACT?

A year ago, in December 2021, 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 followed a November 2011 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 UHC 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.

Though that particular suit is now settled, in October 2021, UHC sued TeamHealth in Tennessee, claiming the insurer up-coded claims totaling about $100 million. TeamHealth has so far failed in its attempts to have a federal judge dismiss that case.

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.

THE LARGER TREND

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.

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.
 

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