On January 12, 2022, the closely watched Nevada lawsuit filed by emergency medicine providers against one of the largest health insurance companies in the world—UnitedHealthcare Insurance Company—was again the focus of hundreds of thousands of providers throughout the country.
The recent hearing followed a seven-week trial during which the jury found that United and its affiliates deliberately underpaid frontline healthcare workers for emergency medical services. The jury awarded $60 million in punitive damages and $2.65 million in compensatory damages to three Nevada-based emergency physician group affiliates of TeamHealth, a physician services and staffing company.
The January 12, 2022 hearing focused on a series of motions submitted by United to withhold allegedly proprietary information introduced during the trial from the public. In an effort to shield this information, United argued that disclosure of its strategic business plans, financial data, rate structures, and pricing—including, but not limited to, the hotly-contested reimbursement amounts and allowed amounts for these particular emergency physician medical claims—would infringe upon United’s privacy interests. United further claimed that the disclosure would put it at a competitive disadvantage during any future contract negotiations with providers.
The Court denied United’s motion to seal with respect to trial evidence concerning reimbursement rates, allowed amounts, and the medical claims at issue in the litigation (with the exception of protected health information). In doing so, Judge Nancy Allf noted that “I have no dog in the fight, but the jury believed the Plaintiffs based upon that evidence. I just can’t keep that away from the public.” Notwithstanding this decision, the Court did find that a few of United’s business plan documents should be sealed.
The jury verdict and the Court’s recent ruling about United’s business records are a win for the providers who have been seeking more transparency in health insurance company pricing of its claims to providers. The issues decided in this case are directly relevant and applicable to similar lawsuits that have spawned across the country. We also are in the first month of the new federal No Surprises Act that became effective January 1, 2022. This new federal program also is subject to challenges in various courts (as discussed here). It is important to closely monitor these issues with respect to provider-payor contracting and reimbursement disputes.
©2022 Epstein Becker & Green, P.C. All rights reserved.National Law Review, Volume XII, Number 31
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