UnitedHealthcare to cut ties with Envision, citing ‘highly questionable’ billing

UnitedHealthcare plans to terminate its contract with the largest emergency room staffing company in the country by the beginning of next year amid allegations of "egregious billing practices." 

Envision Healthcare, which staffs emergency departments in hospitals across the country, accused the insurer of breaching a 2009 contract in a complaint (PDF) filed last month. Envision claimed United “failed to add or ‘affiliate’ new Envision provider groups” as outlined in the contract and “unilaterally” decreased contractual rates.

The insurer returned fire this week in a court filing (PDF), indicating that it “opted to terminate its agreement with Envision effective no later than January 1, 2019." The insurer cited Envision’s “highly questionable billing practices and lack of candor” as some of the reasons it was canceling the contract and urged the U.S. District Court for the Southern District of Florida to push the case into arbitration. 

UnitedHealthcare added that Envision’s fees were, on average, 975% higher than Medicare fees.

“In addition, disturbingly, Envision charges nearly double what UHC sees from hospitals who manage their own ERs,” it wrote in a court filing.

RELATED: 2 physician groups agree to pay more than $33M to resolve patient referral kickback case

According to a review of claims following Envision’s 2016 merger with another physician management group, Sheridan Healthcare, UnitedHealthcare said the company “engaged in an improper game of hide-the-ball from UHC” by increasing charges without notifying the insurer, leading to “millions of dollars of overpayments.”  

UnitedHealthcare’s decision to cut ties with Envision was first reported by Axios. It’s not the first time Envision has been criticized for its billing procedures. The company’s subsidiary, EmCare, has been accused of sending patients surprise medical bills in what one provider executive called a “real fiasco.”

In September, Sen. Claire McCaskill, D-Mo., sent a letter to the company demanding an explanation about EmCare’s surprise billing and accusations that it pressured physicians to order expensive, unnecessary tests. In December, EmCare agreed to a $29.6 million settlement with the Department of Justice to settle claims that it took kickbacks from a now-defunct hospital chain to refer patients for inpatient admissions when they should have been treated as outpatients.