Litigation against UnitedHealthcare
In October 2021, TeamHealth began a trial against UnitedHealthcare in the 8th District Court of Clark County, Nevada. TeamHealth alleges that the insurer underpaid claims made by three Nevada-based affiliates by as much as $10.5 million for emergency department care.[38]
According to a statement from the company, “TeamHealth’s case will prove that United was orchestrating this [underpayments] scheme at the expense of frontline healthcare providers and their patients amid a devastating pandemic. Attorneys found that in many cases United was being paid more to process or adjudicate the patient’s claim than the front-line clinicians who provided the emergency care. Compromising the quality of emergency medical care in a natural disaster, a mass casualty event, or in any community is a risk no one can afford. This is why TeamHealth is standing up against United.”[39]
On November 29, 2021, after more than three weeks of testimony and two days of deliberation, the Clark County, Nevada jury found unanimously in favor of TeamHealth that UnitedHealthcare engaged in unfair reimbursement practices by deliberately failing to pay frontline emergency room doctors adequately for care provided to patients.[40]
The jury awarded TeamHealth $2.65 million in compensatory damages after finding UnitedHealthcare "guilty of oppression, fraud, and malice" by clear and convincing evidence. In a separate punitive damages phase, the jury unanimously awarded the provider group $60 million in punitive damages in addition to the compensatory award.[41][42]
In a statement, TeamHealth President & CEO Leif Murphy stated that the company “look[s] forward to continuing the fight against United in nine future cases that will be decided on the same set of facts.” TeamHealth has similar cases pending against United in New Jersey, Pennsylvania, New York, Florida, Oklahoma, and Texas.[43]
In one instance discussed in Nevada court, United reimbursed only $254 for a gunshot wound treatment billed at $1,428, despite testimony from a former United executive calling the total price tag “reasonable” and "worth" the charge for saving a life.[44]
Several days before opening statements began, United filed a lawsuit in Tennessee Federal District Court alleging that TeamHealth up-coded charges.[45] However, courts have repeatedly dismissed these claims in other jurisdictions, including the 8th District Court in Nevada along with courts in Arkansas, Texas, Tennessee, Mississippi, and Georgia.[46][47] According to a statement from TeamHealth, “This frivolous lawsuit is a calculated effort to divert attention away from the court case commencing Monday in Las Vegas.”[48]
Unsealed documents revealed that United HealthCare provided the anonymous data for Yale University economist Zack Cooper’s 2016 study on surprise medical billing, and made editorial suggestions. The National Institute for Health Care Management, whose board of directors is composed of health insurance executives, also provided financial support for Cooper’s work.
The research, presented at the White House, the U.S. Department of Justice, the Federal Trade Commission, and elsewhere, was publicized as a rigorous academic research study.[49] While the lawsuit revealed that the study's anonymous data was provided by United HealthCare, other studies replicated the results using data from other insurance companies.[50] The study's conclusions were used to advance a formula that allows insurance companies to determine payments to out-of-network physicians.
The study was widely cited by both national media outlets and members of Congress and has since heavily impacted the Biden administration’s implementation of the “No Surprises Act.”[51][52]
