December 07, 2021
UnitedHealthcare must pay $62.65 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.
“We will be appealing this decision immediately in order to protect our customers and members from private equity-backed physician staffing companies who demand egregious and anticompetitive rates for their services and drive up the cost of care for everyone,” a UnitedHealthcare spokesperson wrote in an email.
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 and sets a precedent for all health insurers, TeamHealth CEO Leif Murphy said in a news release. TeamHealth subsidiaries in Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas are all challenging UnitedHealthcare’s reimbursements.
“We look forward to continuing the fight against United in nine future cases that will be decided on the same set of facts,” Murphy said.
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. TeamHealth has said this case represents an attempt to distract from its complaint, and includes evidence from the insurer that the jury was not allowed to hear in the Nevada suit.
This article has been updated with comments from UnitedHealthcare and TeamHealth.