Fremont serves more than 300,000 patients every year, according to a July 13 news release from the group. The lawsuit alleges that UnitedHealthcare’s downcoding policy “arbitrarily reduces payments to clinicians who have provided life-saving emergency care” to its members.
Court documents cited a baby with a severe head injury that received emergency care from Fremont. UnitedHealthcare allegedly denied coverage and later underpaid for the treatment, which Fremont claims is a violation of the No Surprises Act and the Employee Retirement Income Security Act.
“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 Scott Scherr, MD, 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.”
A UnitedHealthcare spokesperson told Becker’s the company is still reviewing the filing.
The two organizations have a contentious legal history with one another. A jury ruled in December that UnitedHealthcare must pay $60 million in punitive damages after losing a Nevada lawsuit against TeamHealth over thousands of provider underpayments for emergency services.
In October, UnitedHealthcare sued TeamHealth in a Tennessee federal court for allegedly upcoding claims to deceive the payer into overpaying for emergency services. The lawsuit claims United overpaid $100 million on claims submitted by TeamHealth since 2016. In May, the judge refused TeamHealth’s request to dismiss the lawsuit, according to Law360.
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