Jury selection is scheduled to enter its fifth day Monday in the long-anticipated showdown between insurance behemoth United and three groups of Nevada emergency department clinicians. The clinicians, who filed their case in Clark County, Nevada district court in April 2019, seek $10.5 million in compensatory damages, plus punitive damages.
At issue is whether or not United has paid the appropriate rate for more than eleven thousand claims that arose when the clinicians provided emergency care to United insureds. The clinicians allege gross underpayments which pose grave financial harm to them in light of their commitment never to balance bill patients. Ironically, it is this commitment that emboldened United to kick emergency providers across the country out of network in 2019 and perniciously start lowering reimbursement payments.
TeamHealth has ten cases pending against United regarding these gross underpayments, seeking tens of millions of dollars. Despite United’s campaign of delay and obstruction, discovery has revealed an intentional scheme under which provider contract terminations are a huge generator of United’s internal profit – creating over $1 billion in revenues annually. The nature of the scheme is as yet unknown to United’s stakeholders but is expected to be revealed in the course of the looming trial.
United’s profits come from United’s so-called “Shared Savings Program,” which provides United a percentage of the “savings” the company achieves by systematically underpaying out-of-network providers. United bases its administrative fee on the difference between undiscounted billed charges and the amount that the company actually pays – not on the smaller difference between prior contracted rates or rates historically accessed from rental networks. The administrative fee routinely exceeds the amount allowed the provider. United recognizes the terrible optics that creates – but proceeds anyway because this scheme generates billions of dollars.
United anticipated at the outset of its Shared Savings scheme that its members would be exposed to balance bills. To reduce that potential exposure, United launched a nefarious multi-part plan to get balance billing outlawed. First, United recruited “independent” academic researchers to advance a narrative that private equity backed physician groups were terminating contracts and seeking payment of billed charges. This became the Yale Study authored by Zack Cooper. Cooper’s paper blames physicians – not United – for surprise billing, but by his own admission states, “Unfortunately, there is no systemic evidence on the frequency that patients are balance billed or exposed to the full costs of an episode of care.”
With its “independent” study in hand, United lobbied Congress to ban balance billing and advanced a formula that allowed United to determine appropriate payments to out-of-network physicians (its own manipulated median contracted rate).
United is so embarrassed about its conduct and the facts that will come out at trial that they have repeatedly tried to seal the courtroom and keep the evidence out of the public eye – and away from the Congressmen they misled with their tainted and biased “study.” Nonetheless, our legal team has successfully fought to shine the light on United’s nefarious conduct, and beginning Tuesday, those facts will finally be in the public arena.
The Nevada trial should be the most significant view behind the managed care curtain in recent history – all of which has been largely attorneys’ eyes only going into the trial.
About TeamHealth
At TeamHealth, our purpose is to perfect the practice of medicine, every day, in everything we do. We are proud to be the leading physician practice in the U.S., driven by our commitment to quality and safety and supported by our world-class operating team. To improve the experience of our physicians and advanced practice clinicians, we empower clinicians to act on what they believe is right, free clinicians from distractions so they can focus on patient care, invest in learning and development to promote growth in the clinical field and foster an environment where continuous improvement is a shared priority. Through our more than 15,000 affiliated healthcare professionals and advanced practice clinicians, TeamHealth offers emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic surgery, general surgery, obstetrics, ambulatory care, post-acute care and medical call center solutions to approximately 2,900 acute and post-acute facilities and physician groups nationwide. Join our team; we value and empower clinicians. Partner with us; we deliver on our promises. Learn more at www.teamhealth.com.
The term “TeamHealth” as used throughout this release includes Team Health Holdings, Inc., its subsidiaries, affiliates, affiliated medical groups and providers, all of which are part of the TeamHealth organization. “Providers” are physicians, advanced practice clinicians and other healthcare providers who are employed by or contract with subsidiaries or affiliated entities of Team Health Holdings, Inc. All such providers exercise independent clinical judgment when providing patient care. Team Health Holdings, Inc., does not have any employees, does not contract with providers and does not practice medicine.