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TeamHealth’s claims that UnitedHealthcare shortchanged 11,500 claims worth $10.5 million went forward in Clark County, Nevada District Court on Tuesday, with the lawsuit’s complaints mirroring those of nine other cases the private equity-backed provider has pending against the nation’s largest insurer, all accusing UnitedHealthcare of underpaying its bills by tens of millions of dollars.
UnitedHealthcare’s most recent federal suit is simply an attempt to distract from the ongoing case in Las Vegas, TeamHealth wrote in an email. In the run-up to the trial, the insurer tried to raise upcoding as a defense, but the court dismissed the charge, the company said.
“The filing of the suit by UnitedHealth in Tennessee last Thursday alleging upcoding violations and the corresponding media blitz is undoubtedly an attempt to influence the Las Vegas jury in a manner that UnitedHealth could not do directly,” TeamHealth said.
Read more: UnitedHealthcare sues TeamHealth, alleges fraud
In its suit, UnitedHealthcare alleged TeamHealth deliberately and systematically tricked the insurer into paying more than $100 million in fraudulent claims. The company’s claims echo those of other lawsuits and scientific analysis, although the insurer facilitated the main study of TeamHealth’s impact on healthcare costs.
In 2017, Yale researchers analyzed more than 2 million claims from one large insurer to find that, when TeamHealth took over a handful of primarily not-for-profit emergency departments, out-of-network billing increased. The rates of tests ordered, use of the highest billing code and patients admitted from the ER into a hospital also rose, although not at the rate of out-of-network bills. For access to the company’s claim data, the original study did not name UnitedHealthcare as the insurer, although court filings TeamHealth leaked to The Intercept later revealed that Yale researchers relied on the company’s bills for research.
This was the first major study to pin surprise billing on private equity-owned staffing companies, and eventually helped convince Congress to pass the No Surprises Act. Come January 1, 2022, the law bars balance billing for emergency services and high out-of-network cost-sharing, forcing providers and payers to agree on a price or take the dispute up with an independent arbitrator.
The claims in TeamHealth’s lawsuits represent an attempt to distract from the unreasonable, high rates TeamHealth demands from payers, which is what led them to fall out of UnitedHealthcare’s network in the first place, a UnitedHealthcare spokesperson wrote in an email. The company’s private equity owners are bent on generating additional profits, which contribute to rising healthcare costs overall, the spokesperson said. Private equity firm Blackstone Group purchased TeamHealth in 2017 for $6.1 billion.
“We are committed to addressing these unreasonable and anticompetitive rates that many private equity-based physician staffing companies charge for services, which drive up the cost of care for our customers, members and the healthcare system,” the UnitedHealthcare spokesperson said.
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TeamHealth argues that researchers’ reliance on UnitedHealthcare’s data taints their results. The company also argues that UnitedHealthcare used the “biased” study to manipulate the median contracted rate it offers TeamHealth, ensuring the rate any arbitrator decides after the new law is effective will be lower than what the market demands.
Questions about Yale researchers’ data use agreement with UnitedHealthcare are “very unfair,” hold an “ethical bent” and are a “total hit job,” said Erin Duffy, a research scientist at the USC Schaeffer Center for Health Policy & Economics.
“A lawsuit that is related to setting the in-network rates for 2019 might be a signal that someone is trying to influence the qualifying payment amounts going forward, but neither of these suits address that,” Duffy said of UnitedHealthcare and TeamHealth’s complaints. “I think that these suits may have come forward anyway.”
TeamHealth’s Las Vegas case comes on behalf of its subsidiary Fremont Emergency Services, alleging that UnitedHealthcare shortchanged physicians for 11,500 claims worth $10.5 million in 2019. That year, TeamHealth apparently pledged not to balance bill out-of-network patients and, when UnitedHealthcare learned of the practice, the insurance giant terminated all of its in-network contracts and began reimbursing the company at unlawfully low rates, TeamHealth said.
In one instance, TeamHealth physicians treated a patient with a gunshot wound, and United reimbursed them less than a fifth of what they were owed, TeamHealth attorneys said. In other cases, claims were paid at 80% less than what they asked for.
By underpaying TeamHealth clinicians, UnitedHealthcare was able to widen the gap between the savings it achieved for its self-insured clients and pocketed the spread, TeamHealth said. Emails and other documents from UnitedHealth Group officials show that contract terminations generate more than $1 billion in revenue annually, according to the company.
The company seeks compensatory damages of $10.5 million, along with punitive damages.
“At the end of this case we’re going to ask you to say, ‘enough is enough.’ We’re going to ask you to say, ‘Make them stop short changing us, to reimburse us what we’re entitled to be paid,'” Pat Lundvall, a partner at the McDonald Carano law firm representing TeamHealth, said during the opening arguments in the Las Vegas court.
The allegations in the Las Vegas case mirror the claims of the other TeamHealth lawsuits, the company wrote in an email.
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