'Cold, callous and inhumane': UnitedHealthcare, Envision battle in federal court

UnitedHealthcare and Nashville-based Envision Healthcare have each filed a lawsuit against the other in a Tennessee federal court over a disagreement about payments for emergency care.

The two organizations have been out of network with each other since Dec. 31, 2020, after the two parties were unable to reach an agreement over reimbursement rates.

Envision Healthcare, a physician services company, sued UnitedHealthcare Sept. 8 for allegedly engaging in an unlawful scheme after the split to "enrich its overflowing coffers" by denying emergency room claims for its highest-acuity patients.

UnitedHealthcare sued Envision Sept. 9, claiming the company "deliberately upcoded thousands of claims" and deceived the payer into overpaying by millions of dollars for emergency care, starting Jan. 1, 2021.

"United's scheme to deny patient claims violates federal law," Envision Healthcare CEO Jim Rechtin said in a news release. "Improperly withholding payment from the very frontline clinicians who treated their members in their most acute time of need is, in my opinion, cold, callous and inhumane."

UnitedHealthcare said in its lawsuit it attempted to negotiate the issue with Envision by providing the company with a draft of the suit.

"Envision took United's confidential complaint … and quickly and quietly drafted its own complaint based on United's and filed it without warning in an effort to beat United to the courthouse," the lawsuit said. "Envision has now attempted to recast United as the villain."

Envision, a medical group that operates in 1,800 facilities across 45 states, filed another lawsuit against UnitedHealth Group in May accusing the healthcare giant of forcing physician groups out of network in an effort to recruit them to its subsidiary Optum.

In its Sept. 8 suit, Envision alleges the percentage of its commercial claims denied by the payer following the split rose from 18 percent to 48 percent of all claims. The denial rate for level five claims, which receive the largest reimbursement, rose to 60 percent, according to the suit.

In addition, the Envision lawsuit claims UnitedHealthcare "employed shadow public relations campaigns" against the medical group and staged an academic study at Yale in 2016 to serve its business interests and influence legislation in Congress.

The lawsuit does not specify how much Envision is seeking in damages, but it wants a jury trial and is seeking no less than $1 million. UnitedHealthcare also wants a jury trial and claims Envision is responsible for paying back three times the damages incurred upon United, though that amount will be determined at trial.

A similar situation is ongoing between UnitedHealthcare and another physician services company, TeamHealth.

In October 2021, UnitedHealthcare sued Las Vegas-based TeamHealth for allegedly upcoding claims to deceive the payer into overpaying a total of $100 million for emergency services.

But a jury ruled in December that UnitedHealthcare must pay $60 million in punitive damages after losing a lawsuit against TeamHealth over thousands of provider underpayments for emergency services.

Fremont Emergency Services, a subsidiary of TeamHealth, filed another lawsuit in July against UnitedHealthcare, accusing the payer of arbitrarily reducing payments to clinicians providing emergency care.

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