Evidence Reveals United’s Nevada Physicians Charged 30% More than TeamHealth for Out-of-Network Emergency Services
The Nevada state court showdown between TeamHealth and United is now in its fifth week. United is expected to rest its case today, with closing arguments to follow immediately thereafter. Jury deliberations are likely to begin late afternoon.
United’s defense has relied heavily on two expert witnesses, Bruce Deal and Alexander Mizenko. Deal, an economist with the Analysis Group, testified first for United. On cross-examination, TeamHealth asked Deal about United-owned Sound Physicians, a large national physician services company. Deal testified he was aware of Sound Physicians, but didn’t know they had started doing business in Nevada in 2019. TeamHealth asked Deal whether Sound’s billed charge of $1,761 for a Level 5 emergency department claim in Nevada was “egregious.” Although United has long claimed that TeamHealth’s clinicians were “egregious billers,” a term it has used frequently in internal documents and in affiliation with its “Egregious Billers Program,” Deal responded, “I’m not sure what you mean by egregious.” TeamHealth then pointed out that its team of Nevada physicians’ charge for a Level 5 claim are “a little under $1,400,” compared to the almost $1,800 charged by Sound. Deal had no response to that comparison.
United next called Alexander Mizenko, manager of products and analytics of FAIR Health Incorporated (“Fair and Independent Research”), an independent non-profit created by United and other health insurance companies in 2009. United offered Mizenko’s testimony to show how TeamHealth’s charges in Nevada compare to various FAIR Health benchmarks. Under cross-examination, however, it became clear that data United provided to Mizenko related to theoretical charges and not to any actual disputed claims. Furthermore, Mizenko acknowledged that TeamHealth’s claim evidence – which United had not provided him – demonstrated that Sound Physicians charged more than TeamHealth for comparable claims in the same geographic locations during the same time period.
United rounded out its case with expert witness Karen King, followed by videotaped testimony of TeamHealth Senior Vice President of Revenue Kent Bristow, and MultiPlan executive Sean Crandall.
Houston-based attorney John Zavitsanos of the AZA law firm will deliver TeamHealth’s closing statements, and Lee Blalock of O’Melveny will deliver United’s closing statements.
“TeamHealth is focused on providing safe, competent, high quality and compassionate evidence-based care to all patients. Their responsiveness to the personal and professional needs of their providers is notable,” said Carla Farrell, DNP, MSN, CRNA, Chief Certified Registered Nurse Anesthetist, TeamHealth Anesthesia. “This focus on patients and clinicians is one of the many reasons I choose to work here.”
TeamHealth’ s more than 15,000 clinicians continue to watch the trial closely. Dr. Robert Frantz, Dr. Scott Scherr, Dr. Brett Hansen, and Dr. Jaime Premerano are among the clinicians who have attended the trial to represent TeamHealth. At stake is the very ability of heroic frontline healthcare providers to get necessary reimbursements from large profitable insurers to cover the cost of the lifesaving care they provide. For more details, see ProtectingOurHealthcareHeroes.com. To watch the proceedings in real-time, tune in to the livestream (Meeting ID: 541 907 772) from 8:00 a.m. to 5:45 p.m. (Pacific Time).
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.