United Healthcare owes $60M to ER doctors, jury rules – Las Vegas Review-Journal

United Healthcare Insurance Co., one of the country’s largest health insurers, must pay $60 million to a group of Nevada out-of-network emergency medical providers, a jury decided Tuesday.
United Healthcare Insurance Co., one of the country’s largest health insurers, must pay $60 million to a group of Nevada out-of-network emergency medical providers, a Las Vegas jury decided Tuesday.
The jury in the 8th Judicial District Court case awarded the millions in punitive damages a week after it found United Healthcare liable of underpaying millions to the three Nevada-based TeamHealth affiliate providers, which includes Fremont Emergency Services (Mandavia) Ltd., Team Physicians of Nevada-Mandavia PC and the parent company of Ruby Crest Emergency Medicine.
TeamHealth did not immediately respond to request for comment.
United Healthcare spokesman Dustin Clark said the company will appeal the decision.
“Everyone agrees health care costs too much, and today’s decision only adds to the problem,” Clark said in an emailed statement to the Review-Journal. “We will be appealing this decision immediately in order to protect our customers and members from private equity-backed physician staffing companies who demand unreasonable and anticompetitive rates for their services and drive up the cost of care for everyone.”
TeamHealth, which was acquired by Blackstone Group in 2017, is a nationwide provider of emergency medical services through more than 15,000 affiliated healthcare professionals and clinicians.
The plaintiffs’ attorney John Zavitsanos and Houston-based law partner Joseph Ahmad had asked the jury to award at least $100 million in punitive damages, saying anything less wouldn’t curb United Healthcare from underpaying ER doctors. The jury already awarded the plaintiffs more than $2 million in damages last week.
“They were able to get away with this until now,” Zavitsanos said to the eight jurors.
Scott Scherr, emergency department director at Sunrise Hospital and Medical Center in Las Vegas and regional medical director of TeamHealth, testified during the monthlong trial.
“A jury of my peers realized the value of emergency medicine in Nevada,” said Scherr, who headed trauma teams treating victims after the Las Vegas mass shooting on Oct. 1, 2017. Fifty-eight people initially were killed and hundreds more were injured. Two survivors later died from injuries suffered in the shooting.
“I hope this sends a message to United Healthcare about the importance of our frontline workers,” Scherr said.
The Nevada breach-of-contract lawsuit was filed in April 2019 by Fremont and two other groups representing critical care providers. It claimed United Healthcare and co-defendants Sierra Health and Life Insurance Co. and Health Plan of Nevada Inc. manipulated reimbursement rates paid to out-of-network providers at hospitals in and around Las Vegas, and in Fallon and Elko.
In emergency rooms, where patients cannot, by law, be turned away, an attending doctor or anesthesiologist may not be covered by the patient’s insurance plan.
Testimony showed that United Healthcare cut reimbursements to out-of-network providers by more than half from 2017 to 2020 — from $528 to $246.
Wayne Dolcefino, a Houston-based media consultant and former journalist who closely monitored the Nevada trial, said he was aware of similar reimbursement lawsuits pending in several other states including Arizona, Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas.
Lawyers for plaintiffs in the Nevada case also accused United Healthcare of creating a false portrait of rising medical costs — tapping Yale researchers to conduct a study on provider price gouging — before Congress last December passed a measure dubbed the No Surprises Act.
The law, due to go into effect in January, prohibits care providers from billing emergency room patients. That leaves providers and insurers to negotiate reimbursement rates among themselves.
Contact Subrina Hudson at [email protected] Follow @SubrinaH on Twitter. The Associated Press contributed to this report.
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