Envision Awarded $91.2M in Arbitration Against UnitedHealthcare
An independent arbitration panel recently awarded $91,270,257.00 to Envision Healthcare (Envision), a private equity-backed national medical group and physician services company, in its arbitration against UnitedHealthcare (UHC) for underpayment for essential medical care. While Envision has other lawsuits against UHC that are still pending, the award stems from UHC’s unilateral reduced reimbursement to Envision clinicians in violation of the parties in-network agreement. In response to Envision’s lawsuit, UHC claimed that it had approached Envision before litigation about alleged upcoding and deceptive practices regarding emergency care provided by Envision and that Envision responded by rushing the subject lawsuit and filing first to beat UHC to the courthouse. The arbitration panel ultimately decided in favor of Envision.
In 2021, UHC was involved in a similar dispute with TeamHealth Holdings (TeamHealth), in which UHC alleged that TeamHealth engaged in fraud by billing for over-inflated medical codes to get greater reimbursement. TeamHealth countersued against UHC, alleging that the insurer’s shared savings plan encouraged the underpayment or termination of physician contracts. Ultimately, a Nevada, jury agreed with TeamHealth and awarded them $60 Million, finding that UHC engaged in unfair reimbursement practices by deliberately failing to pay frontline emergency room doctors adequately for care provided to patients.