UnitedHealthcare sued for allegedly bribing providers to avoid out-of-network referrals

by on

U.S. Anesthesia Partners sued UnitedHealth Group in two states on Wednesday, calling the nation’s largest insurer a “boa constrictor” that allegedly squeezed the 4,000-member physician practice out of so much business it went to the courts to regain its clients.

“United and its affiliates have extended their tentacles into virtually every aspect of healthcare, allowing United to squeeze, choke, and crush any market participant that stands in the way of United’s increased profits,” the physician group’s lawsuit in a Texas state court reads.

In June 2020, UnitedHealthcare canceled its in-network contracts with the Texas provider group, which reportedly represented about 10% of USAP’s annual revenue. In September 2020, United ended its contract with USAP in Colorado, according to another complaint filed in a Colorado state court on Wednesday. The complaint alleges that United violated the Colorado Medical Transparency Act by providing in-network surgeons a 50% bump in premiums for referring business away from USAP, imposing penalties on hospitals that send patients to USAP and providing patients inaccurate and misleading information about the physician group.

USAP has asked for financial relief in both lawsuits, including $1 million in the Texas suit for United’s alleged violations of the state antitrust law, commercial bribery statute and patient solicitation act. The Texas complaint makes similar claims as the Colorado suit and adds that United’s anesthesiology arm also tried to coerce USAP physicians to break their non-compete agreements and work at United-owned facilities.

“United has engaged in strong-arm tactics and anti-competitive practices that are self-serving and that are harming patients, the clinicians who treat them and healthcare facilities,” USAP Vice President Tony Good said in a statement. “It’s time for someone to stand up to United’s bullying tactics.”

UnitedHealthcare said it has not been served either lawsuit yet.

In a statement, UnitedHealthcare said the lawsuit represents “the latest example” of the private equity-backed physician group’s efforts to pressure the insurer into paying almost double the rate it pays other anesthesiology groups in Texas and more than 70% higher than the average rate it pays providers in Colorado. United said its members will still have access to an extensive network of anesthesiologists in both states.

“While these egregiously high rates help meet the profit expectations of their private equity owners, they also drive up the cost of care and make healthcare less affordable for people across the country,” UnitedHealthcare said in a statement.

The case represents the latest flare-up between payers and providers over price, a conflict that has been heightened as more insurers and private equity players get in the provider business, said Paul Keckley, a healthcare analyst.

Along with USAP, United has ended its contracts with Mednax and Team Health Holdings over the past year. A February 2020 survey by the American Society of Anesthesiologists found that 42% of respondents had contracts with insurers terminated in the last six months. The survey listed UnitedHealthcare as the insurer associated with the most contract changes, although it named other insurers. Keckley said this is no surprise: United has increasingly entered into the provider space. Its Optum arm now owns 53,000 physicians across the country, making it the largest employer of physician practices in the U.S. In Texas, the company’s Sound Physicians practice operates as a competitor to USAP and will enter the Colorado market soon, according to the complaints.

“This is not a new song. This is going on all over the place,” Keckley said.

Insurers often prefer fencing patients within their dedicated network to keep costs down and quality high, Keckley said, which is why there has been a rise in “any willing provider” suits in recent years, where states can force health plans to accept all providers who are willing to accept their payment rates and contract terms.

The recent ban on surprise billing could also lead to more dust-ups in this space going forward, said Brad Ellis, senior analyst at Fitch Ratings, as private equity-owned physicians groups are forced to enter into arbitration with hospitals, rather than simply pass big bills onto patients.

“This is something that happens behind the curtain usually, but, once in a while, it pops up,” Ellis said.

U.S. Anesthesia Partners sued UnitedHealth Group in two states on Wednesday, calling the nation’s largest insurer a “boa constrictor” that allegedly squeezed the 4,000-member physician practice out of so much business it went to the courts to regain its clients.
“United and its affiliates have extended their tentacles into virtually every aspect of healthcare, allowing United to squeeze, choke, and crush any market participant that stands in the way of United’s increased profits,” the physician group’s lawsuit in a Texas state court reads.
In June 2020, UnitedHealthcare canceled its in-network contracts with the Texas provider group, which reportedly represented about 10% of USAP’s annual revenue. In September 2020, United ended its contract with USAP in Colorado, according to another complaint filed in a Colorado state court on Wednesday. The complaint alleges that United violated the Colorado Medical Transparency Act by providing in-network surgeons a 50% bump in premiums for referring business away from USAP, imposing penalties on hospitals that send patients to USAP and providing patients inaccurate and misleading information about the physician group.
USAP has asked for financial relief in both lawsuits, including $1 million in the Texas suit for United’s alleged violations of the state antitrust law, commercial bribery statute and patient solicitation act. The Texas complaint makes similar claims as the Colorado suit and adds that United’s anesthesiology arm also tried to coerce USAP physicians to break their non-compete agreements and work at United-owned facilities.
“United has engaged in strong-arm tactics and anti-competitive practices that are self-serving and that are harming patients, the clinicians who treat them and healthcare facilities,” USAP Vice President Tony Good said in a statement. “It’s time for someone to stand up to United’s bullying tactics.”
UnitedHealthcare said it has not been served either lawsuit yet.
In a statement, UnitedHealthcare said the lawsuit represents “the latest example” of the private equity-backed physician group’s efforts to pressure the insurer into paying almost double the rate it pays other anesthesiology groups in Texas and more than 70% higher than the average rate it pays providers in Colorado. United said its members will still have access to an extensive network of anesthesiologists in both states.
“While these egregiously high rates help meet the profit expectations of their private equity owners, they also drive up the cost of care and make healthcare less affordable for people across the country,” UnitedHealthcare said in a statement.
The case represents the latest flare-up between payers and providers over price, a conflict that has been heightened as more insurers and private equity players get in the provider business, said Paul Keckley, a healthcare analyst.
Along with USAP, United has ended its contracts with Mednax and Team Health Holdings over the past year. A February 2020 survey by the American Society of Anesthesiologists found that 42% of respondents had contracts with insurers terminated in the last six months. The survey listed UnitedHealthcare as the insurer associated with the most contract changes, although it named other insurers. Keckley said this is no surprise: United has increasingly entered into the provider space. Its Optum arm now owns 53,000 physicians across the country, making it the largest employer of physician practices in the U.S. In Texas, the company’s Sound Physicians practice operates as a competitor to USAP and will enter the Colorado market soon, according to the complaints.
“This is not a new song. This is going on all over the place,” Keckley said.
Insurers often prefer fencing patients within their dedicated network to keep costs down and quality high, Keckley said, which is why there has been a rise in “any willing provider” suits in recent years, where states can force health plans to accept all providers who are willing to accept their payment rates and contract terms.
The recent ban on surprise billing could also lead to more dust-ups in this space going forward, said Brad Ellis, senior analyst at Fitch Ratings, as private equity-owned physicians groups are forced to enter into arbitration with hospitals, rather than simply pass big bills onto patients.
“This is something that happens behind the curtain usually, but, once in a while, it pops up,” Ellis said.

VA:F [1.9.7_1111]
Rating: 0.0/10 (0 votes cast)
VA:F [1.9.7_1111]
Rating: 0 (from 0 votes)

Leave a Comment

Previous post:

Next post: