UnitedHealth policies drive physicians to Optum, lawsuit claims

Envision Healthcare claims UnitedHealth Group is forcing physician groups out of network in an effort to recruit them to its subsidiary Optum, according to a May 2 lawsuit focused on Florida-based members and providers.

Envision, a physician services company, accused United of forcing providers to take drastically reduced reimbursement rates during contract negotiations, or forcing them out of network. Then, Envision said, United pays providers for out-of-network care at rates lower than the company offered for in-network providers.

The lawsuit also accuses United of targeting large medical groups owned by private-equity firms such as Envision while building out its provider network under the Optum subsidiary.

"While Envision providers participated nationwide with United for years and made significant rate and other contract concessions to maintain that status, United put profits ahead of patients and 'offered' to allow Envision to remain in-network only if Envision providers agreed to take significantly reduced reimbursement that United knew Envision providers could not accept, forcing Envision out of network as part of a scheme to inflate United's profits and grow its Optum business," the lawsuit states.

Envision and Optum are competitors in the primary care and surgical specialist areas. Both have anesthesiologists and ASC chains in their respective networks: AmSurg is part of Envision and Surgical Care Affiliates is part of Optum. Envision accused United HealthCare Insurance of giving Optum providers preferential contracts and reimbursement policies in the lawsuit.

The lawsuit also touches on a conflict between the companies related to a 2018 surgery center deal that fell through. Envision accused Optum of submitting an "apparently bogus" offer for Envision's ambulatory services division, including AmSurg, but backed out after Envision shared commercially sensitive information about the potential sale.

"On information and belief, Optum bid on the Envision services line to obtain sensitive information about Envision's business for the benefit of United HealthCare Insurance, which was engaged in network negotiations with Envision at the time," the lawsuit states.

Finally, Envision also accused United of driving Envision providers out of network so hospitals would turn to in-network, Optum-owned practices for services and "Optum and/or United could acquire some or all of Envision's practices at artificially depressed values."

Envision hopes to recover millions in underpayments with the lawsuit.


Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast