United denied and then underpaid reimbursements for life-saving emergency care treating infants, children, and veterans
Fremont Emergency Services, one of Nevada’s largest emergency medicine groups, serving over 300,000 patients annually, filed suit today against UnitedHealthcare in U.S. federal court in Las Vegas. Fremont seeks a permanent injunction against United’s downcoding policy, which arbitrarily reduces payments to clinicians who have provided life-saving emergency care to patients United insures. The suit will shed light on United’s egregious nationwide scheme, which has unlawfully shifted billions of dollars of costs onto patients, hospitals, taxpayers, and front-line clinicians.
“Despite having faced sanction, jury awards, and settlement payments of some half a billion dollars, United persists in exploiting vulnerable patients and refusing to adequately pay providers,” said Dr. Scott Scherr, medical director at Fremont. “This filing would never happen were it not for United’s ongoing, extensive wrongdoing that puts their billions in profits ahead of patients’ well-being and the needs of the U.S. healthcare system.”
Today’s suit relates to critical emergency care given to a baby with a severe head injury, a boy with a ruptured appendix, and a veteran with heart failure, all of whom were treated by Fremont physicians. United initially denied each of these claims and later significantly underpaid them, having unilaterally determined that each patient’s condition was not serious. Fremont alleges that United’s conduct violates federal ERISA law and the No Surprises Act.
“Our coding of high acuity claims as a percentage of all claims is less than the national averages published by CMS and the Nevada averages published by CMS. Based on our experience under United’s Prepayment Review Program, United must believe that Nevadans who visit our emergency departments experience high acuity illness at a rate that is half the national average. That is simply absurd. In light of the facts here, we ask the court to ban United from employing its downcoding policy that allows the company’s nefarious conduct to victimize United’s members, their employers, and clinicians who deliver life-saving care,” Dr. Scherr continued.
In December 2021, a Clark County, Nevada, jury awarded TeamHealth $60 million in punitive damages from United. The jury found, by clear and convincing evidence, that United had underpaid thousands of claims for the emergency treatment provided by Fremont and was “guilty of oppression, fraud, or malice.” This finding appears to have had no deterrent effect on United or its policies.
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, medical call center, and virtual care 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”), and United HealthCare Services, Inc. (“UHS”). United is the largest health insurer in the U.S., administering care for 26.6 million people across all 50 states, D.C., and U.S. territories.
Plaintiff Fremont is a Nevada professional corporation whose medical professionals staff emergency departments throughout Nevada. These clinicians are on the front lines of responding to and resolving life- and health-threatening medical emergencies in Nevada. For the calendar year 2021, Fremont treated roughly 12,500 patients per month in the Clark County emergency departments in which they practice.
The case is Fremont Emergency Services (Scherr), Ltd. v. UnitedHealthcare Insurance Company and United Healthcare Services, Inc., U.S. District Court for the District of Nevada (filed July 13, 2022).