A jury last week awarded TeamHealth $60 million in punitive damages and late last month awarded TeamHealth $2.65 million in compensatory damages against UnitedHealthcare for underpaying TeamHealth affiliates for out-of-network emergency services. The jury found that UnitedHealthcare was guilty of fraud, malice, and oppression in its conduct.

TeamHealth filed a lawsuit in Clark County, Nevada on behalf of its subsidiary, Fremont Emergency Services, alleging that UnitedHealthcare systematically underpaid its physicians for emergency services provided in 2019. UnitedHealthcare allegedly terminated all of its contracts with TeamHealth after learning that TeamHealth would not balance bill out-of-network patients.

The lawsuit exposed that UnitedHealthcare in some instances paid emergency providers less than 25% of billed charges, and that UnitedHealthcare’s systemic contract terminations of network providers led to increased profits for the payor.

One focal point during the case was a Yale study analyzing millions of UnitedHealthcare’s claims. The study found that out-of-network billings increased when TeamHealth took control of certain providers. However, the study had not taken into account UnitedHealthcare’s own financial incentives to terminate in-network contracts with providers like TeamHealth nor disclosed the communications between the Yale researchers and UnitedHealthcare from 2016 to 2017. The Nevada court compelled UnitedHealthcare to turn over its emails with the Yale researchers revealing UnitedHealthcare’s involvement with the Yale study.

Tellingly, the same Yale study UnitedHealthcare had sought to use here has been attributed with helping persuade Congress to pass the No Surprises Act, which comes into effect on January 1, 2022. The No Surprises Act (the Act) bars certain providers and facilities from balance billing individuals for emergency services. The Act requires providers and payors to try to agree upon an out-of-network price. The Act also sets up a new government run dispute resolution process outside the court system for payment disagreements that remain after attempts at negotiations. Companies like UnitedHealthcare may be hoping that arbitrators selected by the government will be more sympathetic to payors than courts and juries.

TeamHealth has similar, pending court cases against UnitedHealthcare in Florida, Oklahoma, New Jersey, New York, Pennsylvania, and Texas. UnitedHealthcare has also filed a separate lawsuit in Tennessee federal court alleging that TeamHealth upcoded its claims.