UnitedHealthcare beats TeamHealth in Oklahoma trial

An Oklahoma jury has handed UnitedHealthcare a win in its ongoing legal battle with physician staffing company TeamHealth. 

Four TeamHealth subsidiaries filed a lawsuit against UnitedHealth in 2019, accusing the payer of "slashing the rates at which they paid plaintiff [physicians] for their emergency services," allegedly paying "substantially below the rates at which [United] continued to pay other substantially identical claims." 

"One explanation for this disparity is that [United is] reimbursing plaintiff doctors for services provided to members of the plans they fully underwrite at significantly lower rates than they are reimbursing plaintiff doctors for services provided to members of the employer-funded plans for which [United] only provides administrative services," the subsidiaries said in the lawsuit.   

The case went to trial in April, according to court records. The jury found that the TeamHealth subsidiaries "failed to meet their burden to prove the required elements of unjust enrichment." The jury also sided in UnitedHealthcare's favor on TeamHealth's claim for breach of implied-in-fact contract.

"Although we are disappointed with the outcome, we recognize the complexities of the case and respect the jury’s deliberative efforts and its decision," a TeamHealth spokesperson told Becker's. "TeamHealth has prevailed in court against UnitedHealthcare before, and we will continue our nationwide fight to hold corporate health insurers accountable for refusing to provide fair payment for lifesaving care. While United continues to reap record profits from its strategy of putting patients in the middle and cutting provider reimbursement by more than half historic rates, TeamHealth will continue to ensure that patients are not put in the middle of billing disputes."

The verdict is the latest in a contentious legal history between the payer and the Knoxville, Tenn.-based physician staffing company. In 2021, a Nevada jury ordered UnitedHealthcare to pay $60 million in punitive damages after losing a lawsuit to TeamHealth over underpayments for emergency services.  

In October 2021, 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. That case remains pending, according to court records. 

In November 2022, a three-judge arbitration panel in Florida ordered UnitedHealthcare to pay $10.8 million to a TeamHealth clinician group for underpayments from 2017 to 2020. 

In March, a another arbitration panel in Florida ordered UnitedHealthcare to pay TeamHealth $11.3 million for underpayments. 

UnitedHealth did not respond to an inquiry from Becker's regarding how many pending cases between the payer and TeamHealth remain.

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