Protecting Our Healthcare Heroes

TeamHealth continues the fight to defend our Healthcare Heroes.

Large, multi-billion dollar health insurers, led by UnitedHealthcare (United), have been using their market power to lower reimbursements that hospitals and emergency care providers depend on. Insurers continue to aggressively pressure doctors into accepting lower rates, kicking doctors out-of-network (subjecting patients to potential additional out of pocket expenses) if they do not accept.

TeamHealth has steadfastly refused to balance bill patients. Instead, we have taken insurers to court. In late 2021, TeamHealth successfully held United accountable for underpaying frontline doctors in Nevada, with a Clark County jury awarding punitive damages of $60 million.

TeamHealth and our affiliates are fighting to ensure that clinicians are adequately reimbursed for the high-quality care they provide.

Why this matters.

Life-saving emergency medical care is essential to any community, especially during a natural disaster or mass casualty event. TeamHealth proudly answers the call to support our communities when they need us:

Responding to a Mass Shooting: In Las Vegas, Nevada, our clinicians were among the first to treat victims following the deadliest mass shooting in American history. (Watch Video)

Helping Victims of Human Trafficking: TeamHealth’s clinicians have played a key role in identifying and assisting human trafficking victims when they are brought into a hospital setting. (Watch Video)

Keeping Hospitals Fully Staffed Following Hurricanes: TeamHealth clinicians help keep hospitals open and fully staffed so communities impacted by hurricanes and other natural disaster events can continue to receive the care they desperately need. (Watch Video: Hurricane Harvey) (Watch Video: Hurricane Irma)

How we got here.

UnitedHealthcare Prioritized Profits over Patient Care. From the very beginning, United’s goal has been to reap larger profits by artificially and fraudulently reducing payments to physicians.

Lowering Reimbursements & Terminating Contracts. Under a scheme known as “Shared Savings,” United enticed employers to purchase ASO (employee-sponsored) health plans. United then dropped reimbursements as low as possible or kicked doctors out-of-network and then collected profits off the difference between billed charges and reimbursement paid, forcing providers to make up the cost of the care they provided.

Behind-the-Scenes Manipulation. United worked with third-party claim administrator Data iSight to create a faulty database to justify artificially low payment rates to providers. United also worked hand-in-hand with Zack Cooper of Yale University to develop so-called “independent research” to manipulate Congress to push legislation giving large profitable insurers more power over frontline providers.

Holding United Accountable in Nevada.

In late 2021, three of TeamHealth’s Nevada-based affiliates took UnitedHealthcare to trial in Nevada over United’s deliberate failure to pay frontline emergency room doctors adequately for lifesaving care provided to patients.

On November 29th, the jury ruled in favor of TeamHealth, determining that United engaged in “oppression, fraud, and malice” in its conduct, and awarded TeamHealth $2.65 million in compensatory damages.

Two weeks later, the jury reconvened and awarded TeamHealth $60 million in punitive damages for United’s unfair and abusive reimbursement practices. The jury’s decisions were a major victory for frontline healthcare heroes and showed large insurers that they can’t underpay heroic frontline healthcare heroes.

Convincing and concrete evidence presented throughout the trial revelealed that United:

  • Underpaid Frontline Doctors for Lifesaving Care – United paid as little as 20 percent of billed charges. In one instance, United only allowed a $254 charge for a gunshot wound billed at $1,428. When questioned, former United executive John Haben stated that saving somebody’s life was “worth” the $1,428 charged.
  • Exposed Members to Surprise Bills – John Haben also revealed that United exposed its members to surprise medical bills and would only pay if a member complained.
  • Colluded with Zack Cooper of Yale University – The court also uncovered United’s role in colluding with Yale University professor Zack Cooper to produce a controversial study promoting the false view that TeamHealth engaged in balance billing. United provided Cooper with anonymous data, with Cooper promising to hide United’s involvement. As a result, Cooper ignored United’s financial incentive to terminate provider network participation and profit under its shared savings plan provisions with employers. Cooper also allowed United executives to make edits to his conclusions.
  • Profited from their Shared Savings Program at the Expense of Doctors – 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 providers like TeamHealth.

Click here to learn more about the trial in Nevada and read the full list of press releases TeamHealth issued during the proceedings.

Where we go from here.

Upcoming Cases Against United & Other Insurers – TeamHealth’s victory against United in Nevada was just one many legal efforts to ensure that frontline doctors receive the reimbursement they depend on to provide lifesaving care. TeamHealth currently has cases pending against United and other insurers nationwide.

United’s Frivolous Upcoding Suit – In an effort to distract the public from the Nevada trial, United filed a lawsuit against TeamHealth in Tennessee Federal Court in late October 2021 frivolously alleging upcoding. However, courts have repeatedly dismissed these claims in other jurisdictions, including in Nevada, Arkansas, Texas, Tennessee, Mississippi, and Georgia.

Check back in at this page over the coming months to learn how our efforts to hold large profitable insurers like United accountable are progressing.

The story behind the fight to protect our healthcare heroes.

 

 

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