The jury has deliberated; the gavel has landed, and an insurance company is forced to face the repercussions of its actions.
According to a recent article in Modern Healthcare, Tennessee-based emergency physician company TeamHealth has filed ten lawsuits against UnitedHealth Group alleging underpayment. In the first case to be decided, a Las Vegas jury found that UnitedHealthcare did, indeed, shortchange TeamHealth physicians.
Oh, okay. Just shortchanging physicians that are providing critical, life-threatening care to patients. No big deal.
What TeamHealth was seeking: $10.5 million in restitution for the underpayments.
What the courts decided: The jury is still considering punitive damages, but they did award the providers $2.65 million in compensatory damages.
According to the docs, rather than agreeing not to balance bill out-of-network patients, the nation’s largest insurer just killed its contract, and reimbursed at 80% less than the clinicians’ billed.
TeamHealth argued this approach was for UnitedHealthcare’s financial gain, and the jurors seemed to agree. This first case could be an indication of what’s to come in the other nine cases.
But wait, there’s more:
UnitedHealthcare has also sued TeamHealth, claiming that the company “upcoded” its way to $100 million in fraudulent claims since 2016. In other words, they allege TeamHealth’s doctors billed for higher-than-necessary services.
According to TeamHealth CEO Leif Murphy, that case was filed in retaliation – an attempt to distract from the underpayment suit.
These back-and-forth suits illustrate the two sides of the balance billing argument. Insurers continue to claim that doctors and provider groups expect exorbitant reimbursements and refuse to contract at reasonable rates. Meanwhile, providers say that insurance companies demand unsustainable rate cuts, and just walk away from the table if physicians won’t agree.
For now, we’ve heard what Nevada courts had to say, and we’ll do a little victory dance for their decision. But we’ll be watching how the other courts – and the court of public opinion – decide the remaining nine cases.