Five lawsuits have been filed against healthcare giant UnitedHealth Group and its health insurance arm UnitedHealthcare in the last month — including from three ASCs.
Here's what you need to know about the five suits:
1. Taylor Theunissen, MD, and Metairie, La.-based Sadeghi Center for Plastic Surgery filed a lawsuit against UnitedHealthcare, alleging the insurer failed to pay preauthorized claims in violation of the Employee Retirement Income Security Act.
2. Envision Healthcare claims UnitedHealth Group is forcing physician groups out of the network in an attempt to recruit them to its subsidiary Optum. Envision, a physician services company and parent company of ASC management company AmSurg, accused United in a lawsuit of forcing providers to take drastically reduced reimbursement rates during contract negotiations or forcing them out of the network. Then, according to the suit, United allegedly pays providers for out-of-network care at rates lower than the company offered for in-network providers.
3. Advanced Surgery Center in Fort Lee, N.J., filed a lawsuit against UnitedHealthcare for allegedly failing to pay for hernia-related procedures. Working on behalf of a patient with an Employee Retirement and Income Security Act plan, the ASC sought and received preauthorization for the surgical services but was only reimbursed for a fraction of the total amount billed, according to the lawsuit.
4. Surgery Center of Viera in Melbourne, Fla., filed a lawsuit against UnitedHealthcare for alleged repricing and underpayment of a spine surgery performed in 2019. The ASC, which includes neurosurgeon Ara Deukmedjian, MD, and interventional pain management specialist Bharat Patel, MD, operated on a patient who was insured through the Brookdale Senior Living Welfare Plan, which is administered by UnitedHealthcare, according to court documents. The surgery center received authorization to perform the services on the patient but was paid only $16,125.56 on a final bill of $193,438, according to the complaint.
5. An LHC Group shareholder is suing the company and its board of directors over a proposed merger with UnitedHealth Group's Optum unit. Optum announced March 29 that a deal had been reached to purchase the Lafayette, La.-based home-health firm. The $5.4 billion deal is expected to close in the second half of 2022.