UnitedHealthcare underpaid TeamHealth clinicians, jury finds

UnitedHealthcare has lost a round of its legal bout with TeamHealth, a Las Vegas jury decided Monday.

The UnitedHealth Group subsidiary underpaid TeamHealth for emergency services, the court ruled in a decision that accepts the private equity-backed provider group’s allegations that the nation’s largest insurer shortchanged clinicians by $10.5 million.

The verdict closes the book on the first of 10 cases the emergency physicians company has pending against the nation’s largest insurer. TeamHealth subsidiaries in Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas all challenging UnitedHealthcare’s reimbursements.

UnitedHealthcare and TeamHealth did not immediately respond to interview requests.

The case decided Monday began last month, when TeamHealth subsidiary Fremont Emergency Services sued UnitedHealthcare in Clark County, Nevada, District Court. According to the plaintiffs, UnitedHealthcare responded to its 2019 pledge not to balance bill out-of-network patients by terminating its contracts with the provider group and reimbursing them at unlawfully low rates. TeamHealth claimed the insurer paid 80% less than what its clinicians billed.

In this case and the others, UnitedHealthcare countered that TeamHealth’s unreasonably high charges led to its removal from the insurer’s provider networks. The company’s private equity owners are bent on generating additional profits, which contribute to rising healthcare costs, the insurer has argued. Private equity firm Blackstone Group purchased TeamHealth for $6.1 billion in 2017.

TeamHealth asserts instead that UnitedHealthcare undercuts providers for its own financial benefit.

TeamHealth’s trial started days after UnitedHealthcare filed a separate complaint against the provider group in the U.S. District Court for the Eastern District of Tennessee. The insurer alleges TeamHealth deliberately and systematically tricked the insurer into paying more than $100 million in fraudulent claims.

UnitedHealthcare’s claims echo those of other insurers, as well as analyses of how private-equity-owned provider groups behave in the marketplace. According to these sources, companies like TeamHealth eschew contracts with insurance companies and charge high rates, leading to many of the surprise bills patients receive. TeamHealth disputes these conclusions.

When the No Surprise Act limiting surprise billing takes full effect next year, balance billing for emergency services. Payers and providers instead will have to come to agreement or seek judgment from independent arbitrators.

This is a developing story.