A federal judge in New York has tossed UnitedHealth Group's request for summary judgment in one of several legal battles with physician staffing firm TeamHealth.
In the opinion, Judge John Koeltl of the state's Southern District rejected the insurance giant's argument that New York's surprise billing arbitration model bars providers from taking legal action to recover alleged underpayments, which would nullify TeamHealth's litigation.
Koeltl said the insurer did not provide enough evidence to back its assertion that courts in New York have "consistently" deemed these types of legal challenges from providers as invalid. These "arguments are either moot or without merit," Koeltl wrote.
Emergency room doctors at a TeamHealth subsidiary first filed the suit in November 2020, alleging that UHG and provider management firm MultiPlan conspired to underpay them for services provided out-of-network.
According to the suit, UnitedHealth and MultiPlan used the latter's iSight platform to set their own "reasonable" rates for out-of-network claims, which undercut the physicians. The state's surprise billing bars these providers from using balance billing to make up the difference, the docs said.
UnitedHealth issued a filing seeking summary judgment in September, which would resolve the case before it went to trial. The judge told attorneys last summer that the insurer could file a second motion should this first one prove unsuccessful.
The insurer has been embroiled in a legal war with TeamHealth on multiple fronts in several states over reimbursement. A jury in Nevada ruled that UnitedHealth must pay $60 million in damages as part of one case, and a panel in Florida also handed TeamHealth a key win in December.
UnitedHealth, meanwhile, filed suit against TeamHealth in Tennessee in October 2021, claiming that the company up-coded claims to the tune of $100 million in fraud.
UHG has been similarly embroiled in a legal fight with physician staffing firm Envision, which was cut from UnitedHealthcare's network in January 2021.