The second week of the long-awaited legal showdown between UnitedHealthcare and three TeamHealth Nevada provider groups has concluded, and the first witness, John Haben, remains on the stand. Houston-based attorney John Zavitsanos is cross-examining the former United executive, believed to be one of the masterminds of United’s “Shared Savings” plan. Under that plan, the behemoth health insurance company made more than $1 billion in annual profits from that one scheme, once it was implemented. At the core of the scheme was United’s strategy of drastically slashing reimbursement rates to emergency clinicians, while pocketing billions of dollars for themselves that traditionally would have been paid to providers.
The Nevada trial is the providers’ attempt to recover some $10 million for more than 11,000 claims United has “allowed” but paid at an improperly low rate.
“Let’s be clear,” said Carol Owen, TeamHealth’s Chief Counsel of Revenue Payment Integrity. “United allows our clinicians $254 for the life-saving care reflected in the most serious of the claims at issue. Compare that with the $1,300 per hour insurance companies like United often pay their legal counsel or their testifying experts. Our clinicians save a life for $254; that’s 12 minutes of time for a lawyer or six minutes of time for the pair of experts United engaged for the Nevada case.”
When asked about United’s global strategy and the apparent success of the Shared Savings program, Owen added, “United’s executives conceived and implemented novel and – in our view – unethical methods. They terminated physician’s contracts then slashed their reimbursement, misled United’s customers to enter into ‘savings’ programs where United alleged to have negotiated discounted rates but, in fact, there was no such agreement and created a billion dollar program which actually placed members in personal financial peril.”
Haben, who has already admitted the provider rates here were reasonable, is expected to testify Monday and Tuesday. The trial is expected to continue through the week of Thanksgiving.
The Nevada trial should be the most significant view behind the managed care curtain in recent history, as United marked an extensive number of documents “attorneys’ eyes only” going into the trial. For more details, see ProtectingOurHealthcareHeroes.com. To watch the proceedings in real-time, tune in to the livestream (Meeting ID: 541 907 772) from 9:30 a.m. to 4:45 p.m. Pacific Time. The trial resumes Monday, Nov. 8.
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.