Jury Finds UnitedHealthcare and Affiliates Guilty of Oppression, Fraud and Malice

“United’s Shared Savings Program takes up to a 50% administrative fee on the difference between billed charges and United’s arbitrary payments. United often receives more money on their shared savings fee than they pay to the provider.” 

So, what else is new? This happens all the time. Most plan sponsors don’t know anything about this. Here is another example, Aetna’s shared savings of +9% (Weslaco ISD vs Aetna) And how about Oakland County vs BCBS? Cigna vs Anheiser Busch? There are hundreds of lawsuits over the years addressing this practice. – Bill Rusteberg

November 29, 2021

Nevada Jury Finds UnitedHealthcare and Affiliates Guilty of Oppression, Fraud and Malice in its Conduct against Frontline Healthcare Heroes

Press Release

Clark County Jury Orders United to Pay Millions in Compensatory Damages for Unfair Payment and Reimbursement Tactics

Jury to Convene December 7, 2021, to Award Punitive Damages

Today, a Clark County, Nevada jury convincingly ruled favorably for three Nevada-based TeamHealth affiliates, who took legal action against insurance giant United over substantiated claims of drastic underpayments. After more than three weeks of testimony and two days of deliberation, the Nevada jury found that United engaged in unfair and abusive reimbursement practices by deliberately failing to pay the frontline emergency room doctors adequately for care provided to patients. The jury found the evidence clear and convincing and found that United was guilty of oppression, fraud and malice in its conduct, prompting the jury to assess punitive damages against United.

Several current and former United executives came under scrutiny for revelations uncovered in testimony throughout the trial. Among them:

  • John Haben, the former head of United’s Shared Savings Program, confirmed United’s role in colluding with Yale University professor Zack Cooper to produce a controversial study used to promote the false view that TeamHealth engaged in balance billing. The study misled Congress into passing legislation giving insurers significant leverage over frontline providers.
  • United exposed their members to surprise medical bills.
  • Haben also stated under oath that United paid as little as 20% of the clinicians’ billed charges.
  • United’s Shared Savings Program takes up to a 50% administrative fee on the difference between billed charges and United’s arbitrary payments.
  • United often receives more money on their shared savings fee than they pay to the provider.
  • Throughout all of United’s bad behavior, TeamHealth maintained its policy of not balance billing patients.

“On behalf of our more than 15,000 clinicians, TeamHealth is thrilled by the jury’s decision to hold UnitedHealthcare accountable for the considerable harm they have caused to Nevada emergency room clinicians and their patients,” said TeamHealth President & CEO Leif Murphy. “The court evidence clearly demonstrated that United’s refusal to adequately reimburse emergency medicine physicians was intentional and will no longer be tolerated. TeamHealth looks forward to continuing its efforts to ensure that our frontline clinicians have the resources to provide the high-quality lifesaving care and services patients rely on, from coast to coast.”

Dr. Scott Scherr, Regional Medical Director for TeamHealth and Fremont Service, and one of the more than 100 heroic medical first responders who reported to Sunrise Hospital and Medical Center in the aftermath of the 2017 Las Vegas Mass Shooting, also weighed in on the jury’s decision. “For far too long, emergency room physicians have been crippled by United’s unfair reimbursement practices,” said Dr. Scott Scherr. “Today’s ruling is a major victory for our frontline healthcare heroes who, for years, have played an integral and essential role in protecting the health and safety of the Las Vegas community.”

TeamHealth is committed to ensuring that our frontline healthcare providers can secure the necessary reimbursement from insurers, to cover the costs of the lifesaving care they provide and will continue to do so as we pursue similar legal action against other harmful actors, in pending court cases throughout the United States.

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.

The collective term “United” as used throughout this release references defendants, UnitedHealthcare Insurance Company (“UHIC”), United HealthCare Services, Inc. (“UHS”), UMR, Inc. (“UMR”), Sierra Health and Life Insurance Co., Inc. (“SHL”), and Health Plan of Nevada, Inc. (“HPN”).

Case Name is Fremont Emergency Services (Mandavia), et al. vs. UnitedHealth Group, Inc et al. Case number is A-19-792978-B.

 

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