- UnitedHealthcare has lost another legal fight with TeamHealth in the latest billing salvo between the nation’s largest payer and the private-equity backed provider group.
- A three-judge arbitration panel in Florida ruled this week that UnitedHealthcare underpaid a TeamHealth clinician group from 2017 to 2020, and awarded $10.8 million to TeamHealth. TeamHealth also expects an “additional award of millions of dollars” in prejudgment interest and costs, according to a release.
- But TeamHealth was awarded “only a fraction of what it was undeservedly seeking,” and the panel also ruled against TeamHealth’s implied contract and unjust enrichment causes of action allegations, a UnitedHealthcare spokesperson told Healthcare Dive.
The dispute between UnitedHealthcare and TeamHealth stretches back years and has emerged in a string of litigation as the two jockey over rates — and as TeamHealth’s finances are increasingly pressured by falling emergency room volumes and pricing.
The panel in Tampa, Florida, was deliberating whether UnitedHealthcare, which is operated by UnitedHealth, underpaid TeamHealth subsidiary Gulf-to-Bay Anesthesiology Associates. Judges this week decided that UnitedHealthcare paid TeamHealth clinicians 30% of the amount that they determined to be fair compensation for the care provided.
UnitedHealthcare’s settlement payments against TeamHealth have reached some half a billion dollars against multiple lawsuits, according to TeamHealth Chief Clinical Officer Jay Mesrobian.
Last December, a Las Vegas jury found that UnitedHealthcare had underpaid thousands of claims for emergency treatment, and awarded TeamHealth almost $63 million in punitive damages and other awards.
The physician group argues that UnitedHealthcare routinely underpays its doctors. TeamHealth medical groups currently have eight additional lawsuits pending challenging UnitedHealthcare’s payment practices, including one in the same Florida court alleging underpayment from February 2020 onward.
“We will continue to fight United until they change course and start fairly compensating providers,” Mesrobian said in a statement.
“TeamHealth continues to use litigation to distract from the real reason it no longer participates in our network; it expects to be paid double or even triple the median rate we pay other physicians providing the same services,” the UnitedHealthcare spokesperson said. “TeamHealth’s actions are driving up the cost of health care for everyone.”
Physician groups like TeamHealth are often fingered as a major driver of out-of-network spending, as their clinicians are often out-of-network even at in-network facilities, leaving them free to charge patients unexpected, rates even after collecting a portion of the bill from a patient’s insurer. A 2016 study found out-of-network charges increased significantly after TeamHealth took over a hospital emergency room.
Studies have shown there’s little incentive for physician staffing companies to come in-network with payers, as it’s often impossible for patients to shop for the services their clinicians provide, like emergency medicine and anesthesiology. That means it’s unlikely they’ll see a reduction in patient volume, even if they fail to negotiate contracts with insurers.
Insurers have raised the alarm about such practices being acquired by profit-driven private equity firms. TeamHealth, which was acquired by PE firm Blackstone in 2017 for $6.1 billion, has swelled into a massive emergency medicine provider with more than 15,000 clinicians at 2,700 facilities that control their own billing for services.
In another pending lawsuit filed last October in Tennessee, UnitedHealthcare is suing TeamHealth over allegations TeamHealth refuses to join its networks, and billed the payer more then $100 million in fraudulent claims.
TeamHealth isn’t the only physician network in UnitedHealth’s crosshairs.
In 2020, the payer giant cut ties with Mednax, alleging it was charging more than 60% higher than other firms for similar services; and canceled its in-network contracts with PE-backed U.S. Anesthesia Partners in Texas. And, after threatening to drop investment firm KKR-owned Envision from its network in 2018, UnitedHealthcare made good on its warning in 2021 when the payer cut Envision’s 25,000 clinicians from its network, citing high prices.