December 01, 2022 04:58 PM
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TeamHealth has notched a legal win against UnitedHealth Group, but the long-simmering dispute between the two companies continues.
A Florida court ruled this month that the nation’s largest insurer must pay $10.75 million to resolve allegations it underpaid TeamHealth subsidiary Gulf-to-Bay Anesthesiology Associates from 2017 to 2020. TeamHealth expects to receive millions more in prejudgment interest and costs, according to a news release issued Thursday. The private equity-backed provider group also has another lawsuit against the UnitedHealthcare in progress before the same court, likewise alleging underpayment but covering February 2020 onward.
TeamHealth was awarded a “fraction” of what it sought, with a three-judge panel dismissing claims that UnitedHealthcare held an implied contract and engaged in unjust enrichment, a spokesperson for the insurer wrote in an email. “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 spokesperson wrote.
A group of emergency doctors from Tennessee founded TeamHealth in 1979 to offer outsourced emergency services to hospitals. Blackstone, a private equity firm, acquired the company for $6.1 billion in 2017, and has grown it into a leading emergency medicine provider. TeamHealth employs more than 15,000 doctors who work at more than 2,700 facilities, where it controls billing for its services.
The company has a history with UnitedHealthcare. The insurer’s claims data served as the backbone of a landmark New England Journal of Medicine study that found 22% of the time patients visit an emergency department at a hospital in their insurance network, they receive bills for out-of-network care. The study also found that every time TeamHealth took over a hospital emergency department, out-of-network charges soared. Legislators regularly cited the report as justification for passing the No Surprises Act.
UnitedHealthcare has argued in court that TeamHealth refuses to join its networks. The insurer sued TeamHealth in federal court in October 2021, alleging the physician staffing firm tricked it into paying more than $100 million in fraudulent claims. That case is ongoing.
TeamHealth, meanwhile, routinely argues UnitedHealthcare underpays its physicians. The company and its subsidiaries are suing over alleged underpayments in Arizona, Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas. A Nevada jury ordered UnitedHealthcare to pay $62.65 million for shortchanging TeamHealth clinicians in a ruling last December.
A TeamHealth subsidiary sued UnitedHealthcare in federal court in July, alleging the insurer’s use of an algorithm to automatically downcode and deny claims violates the No Surprises Act. TeamHealth is not asking for compensatory damages in this ongoing case but wants an injunction to end UnitedHealthcare’s use of this technology.
“United persists in exploiting vulnerable patients and refuses to adequately pay providers, despite having faced sanctions, jury awards and settlement payment of some half a billion dollars,” Dr. Jay Mesrobian, national medical director and chief clinical officer at TeamHealth, said in a news release.
