An arbitration panel has handed Envision Healthcare a $91.3 million judgment against UnitedHealthcare over underpaid claims, the physician staffing firm said Tuesday.
The independent, three-member panel from the American Arbitration Association made the ruling March 30, Envision said. The arbitrators will also weigh whether Envision is entitled to attorney's fees as well as prejudgment interest, according to the news release.
The $91,270,257 award covers claims for services provided to UnitedHealthcare members in 2017 and 2018, when Envision was still in UHC's network. The arbitration panel determined that the insurer "unilaterally reduced reimbursement to Envision clinicians in violation of the network agreement," according to the release.
The ruling does not extend to other legal disputes over claims submitted after Envision was removed from UHC's network in 2021.
Jim Rechtin, CEO of Envision, said that while the group is "pleased" with the outcome, it "should not take five years to get paid for the lifesaving care our clinicians provide." He noted that the KKR-owned firm is engaged in three other legal fights with UnitedHealth.
“This decision sets a critical precedent for insurers like UnitedHealthcare to pay in full for the high-quality care its members receive in their most acute time of need,” Rechtin said in the release. “While we are disappointed that we had to take the step of entering into arbitration to compel UnitedHealthcare to pay its bills, we are satisfied with the panel’s decision against UnitedHealthcare and its systematic underpayment to clinicians for the care they provide.”
A spokesperson for UnitedHealthcare told Fierce Healthcare that the company disagrees with the ruling, and noted that the panel "did reject many of Envision’s claims, including damages it was seeking."
"We remain committed to helping contain rapidly rising health care costs for the people and employer customers we’re privileged to serve," the spokesperson said. "We’ll continue efforts to protect our members and customers from the small number of bad actors—often private equity-backed physician staffing companies like Envision—who demand unreasonable and anticompetitive rates for their services and drive up the cost of care for everyone.”
The insurance giant has been engaged in a multifront war with physician staffing firms Envision as well as Team Health over the rates they charge for care. The two companies filed dueling lawsuits in Tennessee in September over reimbursement rates.