the payer giant is accused of forcing physician groups out of network to lure them to its subsidiary, Optum.
UnitedHealth is the target of a lawsuit by Envision Healthcare and several other physician practices, who claim the country’s largest health insurer engages in a nationwide practice of low reimbursement rates for providers to force them out of network.
In doing so, UnitedHealth is allegedly driving physicians to its subsidiary, Optum, and paying providers at rates lower than the company offered for in-network.
Once UnitedHealth forces providers out of network, it allegedly pays the provider less than its billed charges and then charges the patient’s plan a commission or surcharge for the savings. UnitedHealth, however, has no intention of paying the billed charges for out-of-network services and denies entitlement to payment for those charges.
Though Envision and the other medical and anaesthesia practices filed the case in Broward County, Florida, the plaintiffs—who are seeking millions of dollars in underpayments— claim UnitedHealth implements this scheme across the country.
Aside from affecting frontline healthcare workers, UnitedHealth’s actions are also resulting in patients paying more for care while having less access to their providers of choice, according to the lawsuit.
“While Envision providers participated nationwide with United for years and made significant rate and other contract concessions to maintain that status, United put profits ahead of patients and ‘offered’ to allow Envision to remain in-network only if Envision providers agreed to take significantly reduced reimbursement that United knew Envision providers could not accept, forcing Envision out of network as part of a scheme to inflate United’s profits and grow its Optum business,” the lawsuit states.
Envision accuses UnitedHealth of giving preferential treatment to Optum, which isn’t subjected to the same reimbursement rates as other provider groups, resulting in UnitedHealth using its own business to subsidize competition.
The lawsuit highlights an example in 2018 when UnitedHealth directed Optum to submit a “bogus bid” for Envision’s ambulatory services unit to gather sensitive information about Envision’s business for UnitedHealth’s negotiations with the company at the time.
Ultimately, UnitedHealth allegedly wanted to steer Envision’s providers out of network so it “could acquire Envision at artificially depressed values.”
The lawsuit states: “United’s pattern of misconduct has reportedly earned it the nickname ‘evil empire’ among some practitioners, and it is not difficult to see why.”
For More Information: https://www.healthleadersmedia.com/revenue-cycle/unitedhealth-sued-over-low-reimbursement-rate-physicians