Envision Healthcare, a national physician staffing firm, announced on Tuesday that it was awarded $91 million in an independent arbitration panel against UnitedHealthcare to settle disputes about underpayment, Envision said in a statement.
The three-member panel of the American Arbitration Association made the award to Envision on March 30 after it found that UnitedHealthcare had breached a contract and “unilaterally reduced reimbursement to Envision clinicians” in 2017 and 2018 in violation of its in-network agreement, according to the statement.
“While we are disappointed that we had to take the step of entering into arbitration to compel UnitedHealthcare to pay its bills, we are satisfied with the panel’s decision against UnitedHealthcare and its systematic underpayment to clinicians for the care they provide,” Envision CEO Jim Rechtin said in a statement.
The panel will separately assess whether Envision is entitled to be reimbursed for other expenses and attorney’s fees.
A UnitedHealthcare spokesperson said that the arbitrated disputes concerned events when Envision participated in UnitedHealthcare’s network and is unrelated to separate litigation when Envision left the insurer’s network.
“We disagree with the panel’s decision. However, it did reject many of Envision’s claims, including damages it was seeking,” the UnitedHealthcare spokesperson told Healthcare Dive.
The judgment comes as KKR-owned Envision and UnitedHealthcare face off in court over several disputes about physician payments.
Last year, Envision sued UnitedHealthcare, arguing that the insurer routinely denied payment for emergency services provided by the medical group. In one instance, Envision alleged that UnitedHealthcare denied payment for care for a baby with unexplained episodes of turning blue, choking and vomiting.
In response, UnitedHealthcare filed its own lawsuit alleging that Envision “systematically deceived” it, and that United overpaid by millions of dollars after the staffing firm exaggerated patient illness and care in emergency rooms through an industry practice called upcoding.
UnitedHealthcare is facing legal allegations from other physician staffing firms. In July, Team Health filed a lawsuit against the insurer, alleging that UnitedHealthcare denied and underpaid services from its emergency room clinicians.