UnitedHealthcare must pay TeamHealth $62 million for shortchanging clinicians, jury says


UnitedHealthcare must pay $62.65 million in total damages for shortchanging TeamHealth clinicians, a Las Vegas jury decided Tuesday.

The jury unanimously found the nation’s largest insurer guilty of fraud and unjust enrichment, saying it had formed and violated an implied contract with TeamHealth and engaged in unjust and oppressive claims practices. The private equity-backed provider group initially demanded $100 million in punitive damages when it alleged the insurer reimbursed clinicians at unlawfully low rates. The jury awarded the plaintiff $60 million. With the $2.65 million TeamHealth won in compensatory damages last week, UnitedHealthcare’s total obligation reached $62.65 million. UnitedHealthcare will reportedly repeal the ruling.

The case, which started last month in Clark County, Nevada, District Court, came on behalf of Fremont Emergency Services, which alleged that UnitedHealthcare responded to the TeamHealth subsidiary’s pledge not to balance bill out-of-network patients by terminating its provider contracts and lowering its reimbursements by up to 80%.

The award closes the book on the first of 10 cases TeamHealth has pending against UnitedHealthcare. TeamHealth subsidiaries in Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas are all challenging UnitedHealthcare’s reimbursements.

In this case and others, UnitedHealthcare counters 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 argues. Private equity firm Blackstone Group purchased TeamHealth for $6.1 billion in 2017.

The 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 intentionally misled the insurer into paying more than $100 million in fraudulent claims.

UnitedHealthcare and TeamHealth did not immediately respond to interview requests.


Source: modernhealthcare.com

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